At the National Heart Centre Singapore, these patients are now treated with intravenous iron therapy.

An estimated 4.5 per cent of Singaporeans have heart failure — partly due to the higher incidences of diabetes, which leads to ischaemic heart disease — compared to 1 to 2 per cent in the United States and Europe. Ischaemic heart disease, one of the most common causes of heart failure, accounted for about 20.5 per cent of all deaths in Singapore in 2020.

Among heart failure patients here, more than 50 per cent of them are iron-deficient, and this can negatively impact their functional capacity, quality of life and life expectancy, said Assistant Professor Ng Choon Ta (pictured below), Consultant, Department of Cardiology, National Heart Centre Singapore (NHCS).

Iron is required to manufacture red blood cells, so a deficiency can lead to symptoms such as lethargy and shortness of breath.

Treatment available

Intravenous (IV) iron therapy, where iron compounds are delivered to the body through a needle or tube inserted into a vein, can significantly reduce re-hospitalisation and mortality of heart failure patients, according to a global study on iron deficiency in these patients.

The Affirm-AHF (acute heart failure) trial was jointly conducted by researchers from the NHCS and partners in Europe, the Middle East and South America from March 2017 to July 2020.

“The goal was to evaluate IV iron therapy among patients hospitalised for acute heart failure and iron deficiency compared with a placebo,” said Dr Ng, who was also co-principal investigator for the trial.

“The primary outcome was a reduction in total heart failure hospitalisations and cardiovascular death.”

As a result of the findings, heart failure patients with iron deficiency admitted to NHCS since last year have been given iron infusion. “IV iron therapy has become part of the recognised therapy. There is definitely an increase in inpatient administration of IV iron treatment,” Dr Ng said.

A single dose of IV iron takes about 15 minutes to administer and can last patients a few months.

Benefits of IV iron

In the Affirm-AHF trial, IV iron and placebos were randomly administered to 1,100 iron-deficient heart failure patients aged 18 years and above from 121 hospitals. These patients were monitored for a year.

Singapore is the only Asian country to take part in the trial, which was the first randomised clinical trial to study the efficacy, safety and outcomes of iron therapy involving the administration of IV iron in patients with iron deficiency and acute heart failure.

The study found that 26 per cent of patients treated with IV iron were less likely to be re-admitted to the hospital or succumb to heart failure, compared to those who were not given the therapy. “This could be due to the improvement in their functions — they feel less lethargic and breathless,” Dr Ng said, adding that other studies have shown that oral iron supplements are not as effective as IV iron therapy.

When iron is administered intravenously, it bypasses the gut, and is directly circulated throughout and absorbed into the body to help in the manufacture of red blood cells.

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