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Ferric derisomaltose consistently reduces heart failure hospitalizations and cardiovascular death in iron-deficient HFrEF patients across all age groups, including those over 79 years.
A new age-stratified analysis from the IRONMAN trial shows that intravenous ferric derisomaltose (FDI) offers consistent benefits for people with heart failure with reduced ejection fraction (HFrEF) and iron deficiency, regardless of age.
FDI has been previously shown to boost clinical outcomes in HFrEF, but whether its effects vary between younger and older patients has remained unclear. To address this, researchers carried out a prespecified analysis examining FDI’s effectiveness and safety across four age groups: under 67 years, 67–73 years, 74–79 years, and over 79 years. The IRONMAN trial was a randomized controlled study with blinded endpoint assessment.
It enrolled 1,137 patients with HFrEF and iron deficiency, who were assigned to receive either FDI or standard care. The key endpoint was a composite of cardiovascular-related mortality and recurrent admissions for heart failure. Secondary measures encompassed changes in haemoglobin levels and quality of life scores. Analyses accounted for recurrent events using the Lin method, with time-to-first-event comparisons assessed via the Cox proportional hazards model.
Interaction effects between age and treatment were also explored. The median patient age was 73 years. The rate ratios (FDI vs usual care) for the primary outcome were:
The p-interaction value of 0.38 indicated no prominent difference in treatment effect across age groups. Likewise, haemoglobin and quality of life improvements at 4 months were consistent across ages (p-interaction = 0.92 and 0.64, respectively). Older patients in the study tended to have more severe symptoms at baseline, with higher N-terminal-pro B-type natriuretic peptide (NT-proBNP) levels and poorer kidney function, yet safety outcomes for FDI were comparable across all age categories.
To sum up, FDI’s benefits in minimizing heart failure hospitalisations and cardiovascular death, and in improving haemoglobin levels and quality of life, do not diminish with age. This supports FDI use for iron-deficient HFrEF patients of all age groups, including those over 79 years.
Heart
Age-stratified effects of intravenous ferric derisomaltose in heart failure with iron deficiency: insights from the IRONMAN trial
Shirley Sze et al.
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