Associate Professor David Sim with heart failure patient Sumuthi Nadesan at the National Heart Centre Singapore. Madam Sumuthi was given two doses of intravenous iron after her condition worsened in late 2018. Her condition improved significantly after that. PHOTO: NATIONAL HEART CENTRE SINGAPORE
Clinical trial results show treatment is safe, can reduce mortality and rehospitalisations
A new multinational study on iron deficiency in heart failure patients, which may cause anaemia, has found that giving iron intravenously can significantly reduce mortality and rehospitalisation.
At least 6,000 patients are admitted for heart failure each year in Singapore's public sector hospitals alone.
Iron therapy comes as a new lifeline for at least half of them, thanks to the landmark study.
Known as Affirm-AHF, the trials were jointly conducted by researchers from the National Heart Centre Singapore (NHCS) and partners in Europe, the Middle East and South America.
Iron is needed for the production of oxygen-carrying red blood cells and is commonly lacking in patients with heart failure. As a result, patients tire easily during exercise, have poor quality of life and are more likely to be hospitalised or die.
While there have been studies on stable heart failure patients, Affirm-AHF was the first to show a reduction in re-admissions after patients in hospital were given intravenous (IV) iron, Associate Professor David Sim, a senior consultant with the Department of Cardiology at NHCS, said.
A single dose of IV iron takes about 15 minutes to administer and can last patients between six months and a year.
The clinical trials took place from March 2017 to July last year at 121 sites. IV iron and placebos were randomly given to 1,100 patients aged 18 years or older in hospital for acute heart failure and iron deficiency.
Madam Sumuthi Nadesan, a heart failure patient in her 60s, received the IV iron during the trials.
In 2010, Madam Sumuthi was diagnosed with heart failure caused by cardiomyopathy - a disease of the heart muscle that makes it harder for the heart to pump blood to the rest of the body - and placed on medication. She stopped her medication after a year as she was feeling better.
In late 2018, her condition worsened and she was referred to the heart failure team at NHCS. "My lungs felt heavy and it was difficult to breathe," said Madam Sumuthi.
Prof Sim, who is also the director of the heart failure programme at NHCS, noted that her blood levels were low and recommended she join the iron therapy clinical trials.
Madam Sumuthi was admitted and given two doses of IV iron. She was discharged from the hospital the next day and her condition improved significantly after that.
Results from the trials showed that the IV iron treatment was safe and reduced the risk of recurrent heart failure hospitalisations.
When asked about the possibility of excessive iron causing heart failure, Prof Sim said that happens only in patients with haematological disorders, who require regular blood transfusion.
"Iron therapy does not result in excess iron because it is given only when there is proven iron deficiency in the patient, and the status of iron deficiency is rechecked before giving subsequent doses."
The research findings have since been translated into clinical practice at NHCS.
"We have started this therapy on suitable patients in NHCS, and it is well tolerated with minimal side effects. Most patients will experience a better quality of life and exercise capacity after the treatment," said Prof Sim.
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