The evidence for change in peak VO2, 6 minute walk test distance and KCCQ clinical summary score were reported by the study as median and IQR. Therefore, imprecision could not be assessed. The comparison of IV iron with oral iron included the same outcomes (mortality and change in NYHA class) which were also rated as very low quality evidence (n=17 for both). Change in NYHA (data on improvement in NYHA has only been extracted where quality of life data is not reported in a trial), showed a clinical harm of IV iron when compared to oral iron (associated with wide confidence intervals around the effect estimate). Mortality did not demonstrate a clear effect with the confidence interval ranging from a decrease and increase in all-cause mortality. Economic One cost-utility analysis found that iron supplementation was cost-effective compared to no iron treatment for patients with heart failure and iron deficiency (ICER = 3,997 cost per QALY). This was assessed as directly applicable with potentially serious limitations. Chronic Heart Failure Treating Heart Failure NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: 978-1-4731-3093-7 6.2.5.6 Recommendations and link to evidence Recommendation No recommendation Relative values of different outcomes The committee agreed that all-cause mortality, quality of life and unplanned hospitalisation were the most critical outcomes for decision making. The committee agreed that the impact of iron on improvement in exercise tolerance, change in haemoglobin in anaemic patients, withdrawal due to adverse events/tolerability and adverse events (including hypertension, anaphylaxis/hypersensitivity, stroke and gastrointestinal issues) were also important outcomes. The committee discussed the outcome change in haemoglobin and agreed that it was only relevant to capture this information in people who had low baseline haemoglobin levels (people with anaemia) as increasing haemoglobin levels in these people was likely to have a beneficial clinical effect. 