Chronic Heart Failure Treating Heart Failure NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: 978-1-4731-3093-7 6.2.5 Iron supplementation for iron deficiency in heart failure Iron deficiency (both with or without overt anaemia) commonly occurs in heart failure affecting between and a third and half176 of patients, and appears to be related to disease severity176 as well as being an independent predictor of mortality. Iron deficiency in heart failure has been an area of intense research since the last guideline update. One of the postulated mechanisms for iron deficiency in the context of heart failure is malabsorption and therefore the mode of delivery of iron supplementation (oral versus intravenous) has also been an area of investigation. There are currently no specific quality standards addressing this area. 6.2.5.2 Review question: What is the clinical and cost effectiveness of iron supplementation in people with chronic heart failure and iron deficiency? For full details see review protocol in Appendix A. Table 50: PICO characteristics of review question Population People with heart failure who also have iron deficiency (whether or not they are anaemic), are on optimal heart failure medical therapy and are in a community or outpatient setting Interventions Intravenous iron Oral iron Comparisons Each other Placebo Outcomes CRITICAL: Mortality Quality of life Unplanned hospitalisation IMPORTANT: Improvement in exercise tolerance Change in haemoglobin in anaemic patients Withdrawal due to adverse events/tolerability Adverse events (hypertension, anaphylaxis/hypersensitivity, stroke, gastrointestinal) Study design Systematic review of RCTs RCT 6.2.5.3 Clinical evidence A search was conducted for randomised trials investigating the effectiveness of intravenous (IV) or oral iron supplementation, compared with each other or placebo, for patients with heart failure (HF) who also have iron deficiency (ID). and , and IRONOUT HF200 ; these are summarised in Table 51 below. 