Iron deficiency has emerged as a common condition in heart failure patients, with implications for their quality of life and exercise capacity. Understanding the impact of iron deficiency and exploring effective treatment strategies are crucial steps toward optimizing outcomes in heart failure management.

The IRONMAN trial, conducted in the United Kingdom, aimed to evaluate the safety and efficacy of intravenous iron treatment in a predominantly outpatient heart failure population. Randomizing over a thousand patients, the trial compared ferric derisomaltose administration with usual care, assessing the primary outcome of cardiovascular death or heart failure hospitalizations.

While the number of primary outcomes in the ferric derisomaltose arm showed a numerical decrease compared to the placebo arm, statistical significance was not achieved. However, a sensitivity analysis accounting for the impact of COVID-19 revealed a more significant effect of iron supplementation on heart failure hospitalizations and cardiac death. Exploring the interplay between COVID-19, nonadherence, and treatment outcomes raises important considerations for interpreting the results.

In contrast to previous trials like AFFIRM-AHF, the IRONMAN trial focused on an outpatient population and utilized ferric derisomaltose instead of ferric carboxymaltose. By expanding the evidence base, the IRONMAN trial reinforces the importance of assessing iron deficiency and implementing appropriate treatment approaches in heart failure patients.

The findings of the IRONMAN trial underscore the need to consider iron deficiency as a significant factor in heart failure management. Incorporating routine iron studies and tailoring treatment to address iron deficiency may contribute to improving outcomes, enhancing quality of life, and optimizing exercise capacity in heart failure patients.