OBJECTIVES: Iron deficiency/anemia (ID/A) are frequent comorbidities in heart failure (HF), associated with increased morbidity and mortality. Treatment of ID/A includes oral and intravenous iron, but little is known about the effect of different treatments on mortality. This study aimed to determine survival differences between HF patients without ID/A and with untreated ID/A and differences between various iron treatments in a real-world setting, stratified by New York Heart Association (NYHA) classes.

METHODS: A retrospective, matched cohort analysis was conducted using the InGef research database containing German claims data. HF and ID/A were identified by ICD-10-GM codes and iron treatment by ATC codes in 2013. HF patients without ID/A and with untreated ID/A were matched 1:1. Patients with HF and ID/A without iron treatment, with oral or intravenous iron treatment were matched 1:1:1. Matching parameters included age, gender, NYHA class, and baseline costs. Survival was analyzed in a 1-year timeframe using Kaplan-Meier estimators and log-rank tests.

RESULTS: In total, 3,048 HF patients with untreated ID/A were matched to HF patients without ID/A. HF patients with untreated ID/A had a highly significantly lower survival probability than patients without ID/A (p<0.0001). The 1:1:1 matching resulted in 352 triplets. Patients with oral iron treatment showed a significantly higher survival probability than patients without iron treatment in NYHA 3 (p=0.0241). Comparing patients with HF and ID/A receiving intravenous iron to those without iron treatment revealed significant differences in favor of intravenous iron treatment for NYHA classes 2 (p=0.0114), 3 (p=0.0111) and pooled 1-4 (p=0.0046). Comparison of oral and intravenous iron treatment favored intravenous iron treatment in NYHA 2 patients (p=0.0211) and pooled NYHA 1-4 patients (p=0.1276).

CONCLUSIONS: Real-world evidence showed survival disadvantages in HF patients with comorbid ID/A, irrespective of NYHA class. Iron treatment, in particular intravenous iron, is associated with an improved survival probability.