Comparative analysis of the effectiveness of iron therapy with a hepcidin-independent absorption mechanism in patients with chronic heart failure

The aim of this study is to describe anemia in chronic heart failure (CHF) and to evaluate the effectiveness of oral therapy with sucrosomial iron (SiderAL® Forte) in this group. Material and methods. The study included 56 patients with CHF and anemia. Results. Anemia in CHF corresponds to anemia of chronic disease (ACD) with the development of iron deficiency (ID) in 75% of patients. The use of sucrosomial iron leads to a significant increase in hemoglobin and serum ferritin levels, a decrease in the concentration of N-terminal pro-brain natriuretic peptide, an improvement in exercise tolerance, a reduction in the functional class of CHF, and a decrease in mortality over a 2-year follow-up period. Conclusion. The addition of iron preparations with hepcidin-independent absorption to standard CHF therapy shows a significant positive effect across all criteria and can be recommended for this category of patients in routine clinical practice.

1. Tkachenko E.I., Borovkova N.Yu., Buyanova M.V. Anemia in chronic heart failure: a look at the pathogenesis and ways of correction. Doctor. Ru. 2019;2(157):31-36. (In Russian). DOI 10.31550/1727-2378-2019-157-2-31-36

2. Larina, V.N. Anemia in the practice of a general practitioner: a new look at an old problem. Russian Medical Journal. 2019;27(12):44–50. (In Russian).

3. Vatutin N.T., Tara din G.G., Kanishcheva I.V., Venzhega V.V. Anemia and iron deficiency in patients with chronic heart failure. Cardiology. 2019;59(4S):4–20. (In Russian). DOI: 10.18087/cardio.2638

4. Zykov M.V., Kashtalap V.V., Bykova I.S., Poltaranina V.A., Barbarash O.L., Raff S.A., Kosmacheva E.D., Ehrlich A.D. Comorbidity in myocardial infarction complicated by acute heart failure. Russian Journal of Cardiology. 2020;25(7):3427. (In Russian). DOI: 10.15829/1560-4071-2020-3427

5. Ponikowski P., Voors A. A., Anker S. D., Bueno H., Cleland J. G.F., Coats A. J.S.et al. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2016. Russian Journal of Cardiology. 2017;1:7–81. (In Russian). DOI: 10.15829/1560-4071-2017-1-7-81

6. Ezekowitz J.A., O’Meara E., McDonald M.A., Abrams H., Chan M., Ducharme A., Sussex B. Comprehensive update of the Canadian Cardiovascular Society guidelines for the management of heart failure. Canadian Journal of Cardiology. 2017;33(11): 1342 –1433. DOI: 10.1016/j.cjca.2017.08.022

7. Arora N.P., Ghali J.K. Iron deficiency anemia in heart failure. Heart Fail Rev. 2013;18(4):485–501. DOI:10.1007/s10741-012-9342-y

8. Carson J.L., Adamson J.W. Iron deficiency and heart disease: ironclad evidence? Hematology Am. Soc. Hematol. Educ. Program. 2010;2010:348–50. DOI:10.1182/asheducation-2010.1.348

9. Cohen-Solal A., Damy T., Terbah M., Kerebel S., Baguet J.P., Hanon O., Zannad F., Laperche T., Leclercq C., Concas V., Duvillié L., Darné B., Anker S., Mebazaa A. High prevalence of iron deficiency in patients with acute decompensated heart failure. Eur. J. Heart Fail. 2014;16(9):984–91. DOI: 10.1002/ejhf.139

10. Núñez J., Domínguez E., Ramón J.M., Núñez E., Sanchis J., Santas E., Heredia R., González J., Miñana G., López L., Chorro F.J, Palau P. Iron deficiency and functional capacity in patients with advanced heart failure with preserved ejection fraction. Int. J. Cardiol. 2016;207:365–7. DOI: 10.1016/j.ijcard.2016.01.187

11. Stuklov N.I. Iron deficiency and anemia in patients with chronic heart failure. Rational pharmacotherapy in cardiology. 2017;13(5);651–660. (In Russian). DOI: 10.20996/1819-6446-2017-13-5-651-660

12. Silverberg D.S., Wexler D., Schwartz D. Is correction of iron deficiency a new addition to the treatment of the heart failure? Int. J. Mol. Sci. 2015;16(6):14056–74. DOI: 10.3390/ijms160614056

13. Niehaus E.D., Malhotra R., Cocca-Spofford D., Semigran M., Lewis G.D. Repletion of iron stores with the use of oral iron supplementation in patients with systolic heart failure. Journal of Cardiac Failure. 2015;21(8):694–7. DOI: 10.1016/j.cardfail.2015.05.006

14. Rukavitsyn O.A. Anemia of chronic diseases: certain aspects of pathogenesis and ways of correction. Oncohematology. 2016;1(1):37–46. (In Russian). DOI 10.17650/1818-8346-2016-11-1-37-46

15. Chronic heart failure. Clinical guidelines 2020. Russian Journal of Cardiology. 2020;25(11):4083. (In Russian). DOI: 10.15829/1560-4071-2020-4083

16. Karavidas A., Troganis E., Lazaros G., Balta D., Karavidas I.N., Polyzogopoulou E., Parissis J., Farmakis D. Oral sucrosomial iron improves exercise capacity and quality of life in heart failure with reduced ejection fraction and iron deficiency: a nonrandomized, open-label, proof-of-concept study. Eur. J. Heart Fail. 2021;23(4):593–597. DOI: 10.1002/ejhf.2092

17. Fabiano A., Brilli E., Mattii L., Testai L., Moscato S., Citi V., Tarantino G., Zambito Y. Ex Vivo and in Vivo Study of Sucrosomial Iron Intestinal Absorption and Bioavailability. Int. J. Mol. Sci. 2018;19(9):2722. DOI: 10.3390/ijms19092722

18. Gómez-Ramírez S., Brilli E., Tarantino G., Muñoz M. Sucrosomial Iron: A New Generation Iron for Improving Oral Supplementation. Pharmaceuticals (Basel). 2018;11(4):97. DOI :10.3390/ph11040097

19. McDonagh Th.A., Metra M., Adamo M. et al. ESC Scientific Document Group, 2023 Focused Update of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) With the special contribution of the Heart Failure Association (HFA) of the ESC, European Heart Journal. 2023;44(37):3627–3639. DOI: 10.1093/eurheartj/ehad195

20. Baranov I.I., Salnikova I.A., Nesterova L.A. Clinical guidelines for the diagnosis and treatment of iron deficiency conditions: a view from 2022. Obstetrics and gynecology: news, opinions, training. 2022;10(2):56–64. (In Russian). DOI: 10.33029/2303-9698-2022-10-2-5