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Bhatia K, Sabharwal B, Gupta K, Lopez PD, Kaur A, Bhatia HK, Gandhi KD, Niroula S, Correa A, Birati EY, Argulian E, Fox A, Mahmood K. Clinical outcomes of intravenous iron therapy in patients with heart failure and iron deficiency: Meta-analysis and trial sequential analysis of randomized clinical trials. J Cardiol 2024; 83:105-112. [PMID: 37380069 DOI: 10.1016/j.jjcc.2023.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/13/2023] [Accepted: 06/22/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Iron deficiency in patients with heart failure (HF) is underdiagnosed and undertreated. The role of intravenous (IV) iron is well-established to improve quality of life measures. Emerging evidence also supports its role in preventing cardiovascular events in patients with HF. METHODOLOGY We conducted a literature search of multiple electronic databases. Randomized controlled trials that compared IV iron to usual care among patients with HF and reported cardiovascular (CV) outcomes were included. Primary outcome was the composite of first heart failure hospitalization (HFH) or CV death. Secondary outcomes included HFH (first or recurrent), CV death, all-cause mortality, hospitalization for any cause, gastrointestinal (GI) side effects, or any infection. We performed trial sequential and cumulative meta-analyses to evaluate the effect of IV iron on the primary endpoint, and on HFH. RESULTS Nine trials enrolling 3337 patients were included. Adding IV iron to usual care significantly reduced the risk of first HFH or CV death [risk ratio (RR) 0.84; 95 % confidence interval (CI) 0.75-0.93; I2 = 0 %; number needed to treat (NNT) 18], which was primarily driven by a reduction in the risk of HFH of 25 %. IV iron also reduced the risk of the composite of hospitalization for any cause or death (RR 0.92; 95 % CI 0.85-0.99; I2 = 0 %; NNT 19). There was no significant difference in the risk of CV death, all-cause mortality, adverse GI events, or any infection among patients receiving IV iron compared to usual care. The observed benefits of IV iron were directionally consistent across trials and crossed both the statistical and trial sequential boundaries of benefit. CONCLUSION In patients with HF and iron deficiency, the addition of IV iron to usual care reduces the risk of HFH without affecting the risk of CV or all-cause mortality.
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Affiliation(s)
- Kirtipal Bhatia
- Mount Sinai Heart, Mount Sinai Morningside Hospital, New York, NY, USA
| | - Basera Sabharwal
- Mount Sinai Heart, Mount Sinai Morningside Hospital, New York, NY, USA
| | - Kartik Gupta
- Department of Internal Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - Persio D Lopez
- Mount Sinai Heart, Mount Sinai Morningside Hospital, New York, NY, USA
| | - Arpanjeet Kaur
- Department of Internal Medicine, Mount Sinai Morningside/West, New York, NY, USA
| | - Harsimran K Bhatia
- Department of Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | | | - Shailesh Niroula
- Department of Internal Medicine, Beaumont Hospital, Royal Oak, MI, USA
| | - Ashish Correa
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Edo Y Birati
- The Lydia and Carol Kittner, Lea and Benjamin Davidai Division of Cardiovascular Medicine, Poriya Medical Center, Azrieli Faculty of Medicine, Bar-Ilan University, Tel Aviv, Israel
| | - Edgar Argulian
- Mount Sinai Heart, Mount Sinai Morningside Hospital, New York, NY, USA
| | - Arieh Fox
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kiran Mahmood
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Gandhi KD, Omar A, Konje S, Alam L, Moras EC, Mancero B, Zipf EA, Meister D, Kaur A, Pena MK, Lizardo CP, Kim GH, Elias J, Argulian E. PROGNOSTIC VALUE OF EXERCISE ASSOCIATED DIASTOLIC ABNORMALITIES IN PATIENTS WITH ELEVATED RESTING SYSTOLIC BLOOD PRESSURE. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01960-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Mancero B, Omar A, Kim GH, Zipf EA, Elias J, Meister D, Pena MK, Perez C, Gandhi KD, Kaur A, Moras EC, Leber R, Barman N, Argulian E. PROGNOSTIC SIGNIFICANCE OF EXERCISE INDUCED MYOCARDIAL ISCHEMIA IN PATIENTS WITH ANGIOGRAPHICALLY NORMAL CORONARIES COMPARED TO PATIENTS WITH NORMAL EXERCISE ECHOCARDIOGRAPHY. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01768-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Kim GH, Omar A, Konje S, Alam L, Elias J, Zipf EA, Lizardo CP, Pena MK, Meister D, Moras EC, Gandhi KD, Kaur A, Mancero B, Leber R, Barman N, Argulian E. PROGNOSTIC SIGNIFICANCE OF MYOCARDIAL ISCHEMIA DURING EXERCISE IN PATIENTS WITH NON-OBSTRUCTIVE CORONARY DISEASE COMPARED TO PATIENTS WITH NORMAL EXERCISE ECHO. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01602-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Elias J, Omar A, Konje S, Alam L, Kim GH, Zipf EA, Meister D, Lizardo CP, Pena MK, Mancero B, Moras EC, Gandhi KD, Kaur A, Argulian E. PROGNOSTIC UTILITY OF EXERCISE STRESS ECHOCARDIOGRAPHY IN PATIENTS WITH INDETERMINATE RESTING DIASTOLIC FUNCTION. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01957-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Amarnath SK, Joshi S, Abhyankar MN, Adhikary R, Beena HB, Chugh TD, Gandhi KD, Hittinahalli V, Indumathi VA, Rajavari M, Muralidharan S, Rao SS, Roy I, Saini N. Cross-country transport and isolation and identification of Streptococcus pneumoniae by use of alternate sources of blood supplemented media among laboratories in India. Indian J Med Microbiol 2019; 37:363-369. [PMID: 32003334 DOI: 10.4103/ijmm.ijmm_19_82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background The isolation of S. pneumoniae (Sp) depends on specimen integrity / transport, media and expertise. The non-availability of sheep blood agar poses a challenge in identification of colonial morphology and identification in India. Methods Laboratories processed swabs containing either pure Sp or Sp in mixed cultures with a second (confounding) bacterium shipped across the country in cold conditions. Duplicate set of swabs was shipped back to the central laboratory to assess the impact of shipping on culture viability. The identical swab was cultured on sheep, human blood and one additional agar plate used in the laboratory. Results 46/60(77%) of cultures containing only Sp were correctly identified. In specimens where Sp was present in mixed culture, the proportion of isolates in which Sp was correctly identified varied, with most variability attributed to the particular confounding organism rather than the media. There was no discernible impact of temperature-controlled (4-6°C) transport on the isolation of Sp from culture swabs. Conclusions The study clearly elucidates the ability of laboratories for isolation of S. pneumoniae on human blood agar in resource limited settings. The results highlight the difficulties inherent in correctly identifying pathogens in mixed cultures in needs improvement using standardized tests across the study centers. The study also reaffirms the ability to transport biological specimens over long geographical distances without loss.
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Affiliation(s)
| | - Sangeeta Joshi
- Consultant Microbiologist, Manipal Hospital, Bengaluru, Karnataka, India
| | - Madhuwanti N Abhyankar
- Consultant Microbiologist, Golwilkar Metropolis Health Services, (I) Pvt. Ltd., Pune, Maharashtra, India
| | - Ranjeeta Adhikary
- Consultant Microbiologist, Manipal Hospital, Bengaluru, Karnataka, India
| | - H B Beena
- Consultant Microbiologist, Manipal Hospital, Bengaluru, Karnataka, India
| | - T D Chugh
- Sr. Consultant, Department of Microbiology, BL Kapoor Memorial Hospital, New Delhi, India
| | - K D Gandhi
- Consultant Microbiologist, Shanti Mukund Hospital, New Delhi, India
| | - Vivek Hittinahalli
- Consultant Microbiologist, Yashomati Hospital, Bengaluru, Karnataka, India
| | - V A Indumathi
- M.S. Ramaiah Medical College, Bengaluru, Karnataka, India
| | | | - S Muralidharan
- St. John's Medical College Hospital, Bengaluru, Karnataka, India
| | - S S Rao
- SS Microbiology Laboratory, Thane, Maharashtra, India
| | - I Roy
- Consultant Microbiologist, Sri Aurobindo Seva Kendra, Kolkata, West Bengal, India
| | - N Saini
- Consultant Microbiologist, Pushpanjali Hospital, New Delhi, India
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