Rationale and design of the AFFIRM-AHF trial: a randomised, double-blind, placebo-controlled trial comparing the effect of intravenous ferric carboxymaltose on hospitalisations and mortality in iron-deficient patients admitted for acute heart failure

Piotr Ponikowski, Bridget-Anne Kirwan, Stefan D Anker, Maria Dorobantu, Jarosław Drozdz, Vincent Fabien, Gerasimos Filippatos, Teba Haboubi, Andre Keren, Irakli Khintibidze, Hans Kragten, Felipe A Martinez, Theresa McDonagh, Marco Metra, Davor Milicic, José C Nicolau, Marcus Ohlsson, Alexander Parhomenko, Domingo A Pascual-Figal, Frank Ruschitzka, David Sim, Hadi Skouri, Peter van der Meer, Ewa A Jankowska, Piotr Ponikowski, Bridget-Anne Kirwan, Stefan D Anker, Maria Dorobantu, Jarosław Drozdz, Vincent Fabien, Gerasimos Filippatos, Teba Haboubi, Andre Keren, Irakli Khintibidze, Hans Kragten, Felipe A Martinez, Theresa McDonagh, Marco Metra, Davor Milicic, José C Nicolau, Marcus Ohlsson, Alexander Parhomenko, Domingo A Pascual-Figal, Frank Ruschitzka, David Sim, Hadi Skouri, Peter van der Meer, Ewa A Jankowska

Abstract

Aims: Iron deficiency (ID) is a common co-morbidity in heart failure (HF), associated with impaired functional capacity, poor quality of life and increased morbidity and mortality. Treatment with intravenous (i.v.) ferric carboxymaltose (FCM) has shown improvements in functional capacity, symptoms and quality of life in stable HF patients with reduced ejection fraction. The effect of i.v. iron supplementation on morbidity and mortality in patients hospitalised for acute HF (AHF) and who have ID has yet to be established. The objective of the present article is to present the rationale and design of the AFFIRM-AHF trial (ClinicalTrials.gov NCT02937454) which will investigate the effect of i.v. FCM (vs. placebo) on recurrent HF hospitalisations and cardiovascular (CV) mortality in iron-deficient patients hospitalised for AHF.

Methods: AFFIRM-AHF is a multicentre, randomised (1:1), double-blind, placebo-controlled trial which recruited 1100 patients hospitalised for AHF and who had iron deficiency ID defined as serum ferritin <100 ng/mL or 100-299 ng/mL if transferrin saturation <20%. Eligible patients were randomised (1:1) to either i.v. FCM or placebo and received the first dose of study treatment just prior to discharge for the index hospitalisation. Patients will be followed for 52 weeks. The primary outcome is the composite of recurrent HF hospitalisations and CV mortality. The main secondary outcomes include the composite of recurrent CV hospitalisations and CV mortality, recurrent HF hospitalisations and safety-related outcomes.

Conclusion: The AFFIRM-AHF trial will evaluate, compared to placebo, the effect of i.v. FCM on morbidity and mortality in iron-deficient patients hospitalised for AHF.

Keywords: Acute heart failure; Cardiovascular mortality; Ferric carboxymaltose; Iron deficiency; Recurrent heart failure hospitalizations.

© 2019 The Authors. European Journal of Heart Failure © 2019 European Society of Cardiology.

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