Iron for Heart Failure
Verdict: Published with Warning
Across 7 PubMed studies, the evidence for Iron in Heart Failure grades Tier A — moderate evidence. Effective, but with safety or population caveats.
A 🔵 A Moderate Evidence Published with Warning
Why this grade7-layer evidence engine
⚖️
Scoring transparency
All scores computed by a 7-layer evidence engine — fully auditableRaw score 0.72
D
C
B
A
S
← counter-evidence / ineffectiveeffective / strong evidence →
Final grade
A · Published with Warning
Confidence
81%
Highly consistent evidence
Evidence level
E2
Multiple high-quality MAs (≥2 independent, consistent)
▸View the full decision path (audit trail)
- compute_raw_score — 加權公式: L2×0.30 + L3×0.25 + L5×0.25 + L11×0.10 + L1×0.10 = 0.72
- tier_from_score — 依分數區間映射至 tier letter
- apply_hec_rules — 高品質 SR/MA 顯示 positive (3 篇 > 1 negative)
- tier_strict_requirement_check — Tier 條件達標，未降階
- detect_disputes — 偵測到 0 個 hard + 0 個 soft dispute
- decide_status — 依 tier + dispute 結果決定 status
PubMed studies (7)L2 · primary research & systematic reviews
Intravenous iron therapy for heart failure and iron deficiency: An updated meta-analysis of randomized clinical trials
Finding: IV iron reduced the composite of first HF hospitalization or CV death (OR 0.73, 95% CI 0.58-0.92), while all-cause mortality (OR 0.85, 95% CI 0.71-1.02) and CV mortality (OR 0.88, 95% CI 0.76-1.01) showed only non-significant trends.
View on PubMed Impact of Intravenous Iron in patients with heart failure and Iron Deficiency: an updated Meta-analysis of RCTs
Finding: IV iron produced a 21% relative reduction in HF hospitalization or CV death and a 24% reduction in HF hospitalization (both P<0.01), but no significant difference in all-cause mortality (P=0.11).
View on PubMed Efficacy of Intravenous Ferric Carboxymaltose in Heart Failure Patients with Iron Deficiency Anemia: A Meta-analysis of 6271 Patients
Finding: Ferric carboxymaltose reduced first hospitalization or CV death (RR 0.91, 95% CI 0.84-0.98, p=0.02) and improved 6MWD (SMD 1.45, p=0.002) and KCCQ (SMD 1.49, p<0.00001), but all-cause mortality (RR 0.89, p=0.28) and CV death (RR 0.90, p=0.17) were not significant.
View on PubMed Ferric Carboxymaltose in Heart Failure with Iron Deficiency (HEART-FID)
Finding: The largest single RCT MISSED its primary endpoint: win ratio 1.10 (95% CI 0.99-1.23, p=0.019) did not meet the prespecified threshold of p<0.01; death (8.6% vs 10.3%) and HF hospitalization (13.3% vs 14.8%) favored FCM but were not conclusive.
View on PubMed Intravenous ferric derisomaltose in patients with heart failure and iron deficiency in the UK (IRONMAN)
Finding: Primary endpoint was narrowly NOT significant: 22.4 vs 27.5 events per 100 patient-years (rate ratio 0.82, 95% CI 0.66-1.02, p=0.070); a prespecified COVID-adjusted sensitivity analysis was significant (RR 0.76, 95% CI 0.58-1.00, p=0.047).
View on PubMed Oral iron supplementation in patients with heart failure: a systematic review and meta-analysis
Finding: ORAL iron showed NO benefit: no difference in all-cause mortality (RR 0.77, 95% CI 0.46-1.29, p=0.33) or 6-minute walk distance (MD 59.6 m, 95% CI -17.89 to 137.08, p=0.13); it was safe but ineffective.
View on PubMed Effect of iron supplementation in patients with heart failure and iron deficiency: A systematic review and meta-analysis
Finding: IV iron significantly reduced overall (OR 0.52, 95% CI 0.33-0.81, p=0.004) and HF (OR 0.42, 95% CI 0.22-0.80, p=0.009) hospitalizations, but had no effect on all-cause mortality (IV OR 0.97, 95% CI 0.73-1.29, p=0.84) or CV death (RR 0.94, 95% CI 0.70-1.25, p=0.655).
View on PubMed Regulatory & authoritative positionsL4/L5 · FDA / EMA / NIH ODS / Cochrane / Mayo …
L4a US FDA
Supportive
NUTRIENT SUPPLEMENT source↗
L4b EU EFSA
Supportive
contributes to normal oxygen transport in the body source↗
L4c UK NHS
Cautious
You should be able to get all the iron you need from your daily diet. source↗
L4d TW TFDA / 衛福部
Supportive
育齡婦女及懷孕婦女每日建議攝取鐵量為15毫克，至懷孕第3期婦女則應增加每日攝取量至45毫克。 source↗
L4e WHO
Supportive
Daily oral iron and folic acid supplementation is recommended as part of antenatal care source↗
L5a NIH Office of Dietary Supplements
Supportive
Iron is an essential component of hemoglobin source↗
L5b Mayo Clinic
Supportive
Mild iron deficiency anemia usually doesn't cause complications. However, left untreated, iron deficiency anemia can become severe and lead to health problems, including the following: Heart problems. Iron deficiency anemia may lead to a rapid or irregular heartbeat. Your heart must pump more blood to make up for the lack of oxygen carried in your blood when you're anemic. This can lead to an e… source↗
L5c Cleveland Clinic
Supportive
It might be reasonable to treat NYHA class II and III heart failure patients with iron deficiency with intravenous iron to improve functional status and quality of life. (Class IIb recommendation). Definition of iron deficiency: absolute deficiency: ferritin < 100 mg/mL; relative deficiency: ferritin 100-300 mg/mL with transferrin saturation < 20%. The guidelines withhold any recommendations re… source↗
L5d Harvard Health
Cautious
Deposits of iron in the heart can cause heart failure or an irregular heartbeat. ... Avoiding supplemental iron (as contained in supplements and many vitamins) and high doses of vitamin C (which frees iron to deposit in the tissues) also may help to prevent complications of iron overload. source↗
L5e Specialty Society (condition-mapped)
Supportive
only the IV route is considered for iron administration in iron-deficient HF patients (Level of evidence: Class IIA-a). [AHA/IRONMAN context:] Repeated intravenous (IV) administration of iron reduced the risk of hospitalization for heart failure and cardiovascular death. Treatment with IV iron was safe and well-tolerated, and people who received it reported improved well-being. source↗