Ferric Carboxymaltose in Patients With Heart Failure and Iron Deficiency
Ferric Carboxymaltose in Patients With Heart Failure and Iron Deficiency
original article
A BS T R AC T
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Ferric Carboxymaltose in Heart Failure and Iron Deficiency
R
ecent developments in the manage- deficiency with the use of intravenous iron (ferric
ment of chronic heart failure in patients carboxymaltose) confers symptomatic benefits in
with an impaired left ventricular ejection patients with chronic heart failure.
fraction have changed the natural history of this
clinical syndrome and improved patients out- Me thods
comes.1,2 However, the normal daily activities
of many patients with heart failure remain re- Trial Design and Oversight
stricted; they report symptoms of fatigue and From June 25, 2007, through December 31, 2008,
dyspnea that adversely affect their quality of life, a total of 459 eligible patients were enrolled from
leading to high morbidity.3,4 Therapeutic options 75 sites in 11 countries (Fig. 1 in the Supplemen-
to improve functional capacity in patients with tary Appendix, available with the full text of this
heart failure are limited, and novel therapies are article at NEJM.org). The study design has been
needed. published previously.20 The protocol was approved
Numerous mechanisms unrelated to hemody- by the institutional review board at each partici-
namic dysfunction may underlie impaired exercise pating center, and the trial was conducted in ac-
tolerance in patients with chronic heart failure. cordance with the principles of the Declaration
Among them, inadequate oxygen supply and im- of Helsinki, the International Conference on Har-
paired oxygen use by skeletal muscle during exer- monization Good Clinical Practice guidelines, and
cise contribute to poor clinical status.5,6 In addi- local and national regulations. Written informed
tion, anemia may aggravate symptoms in patients consent was provided by all patients before any
with heart failure.7 Targeting these abnormalities study-related procedures were performed.
may confer functional benefits to such patients. The trial was designed, implemented, and over-
Iron plays a key role in oxygen uptake, trans- seen by the FAIR-HF Executive Committee, to-
port, and storage, as well as oxidative metabolism gether with representatives of the sponsor, Vifor
in the skeletal muscle; it also is involved in eryth- Pharma (Glattbrugg, Switzerland). ClinStar (Mos-
ropoiesis.8,9 Traditionally, iron deficiency has been cow) was responsible for on-site monitoring of
considered to have clinical consequences only in sites in Russia and Ukraine. Kendle (Munich, Ger-
the presence of anemia. Alternatively, a reduced many) was responsible for on-site monitoring in
hemoglobin level can be viewed as the end result other countries, in addition to data collection and
of a process beginning with the gradual depletion data management. SOCAR Research (Nyon, Swit-
of iron stores.9,10 Iron deficiency in patients with zerland) was responsible for data analysis. Anal-
or without anemia attenuates aerobic performance yses were performed independently of the spon-
and is accompanied by reports of fatigue and ex- sor, according to a predefined plan of statistical
ercise intolerance.11 The repletion of iron in pa- analysis. The medical statistics unit at the Lon-
tients who have iron deficiency without heart don School of Hygiene and Tropical Medicine
failure improves cognitive, symptomatic, and ex- performed the same analyses, separately, with
ercise performance.12,13 identical results. The manuscript was prepared and
Recently, it has been recognized that patients submitted for publication by the FAIR-HF Execu-
with heart failure may be prone to the develop- tive Committee. An independent data and safety
ment of iron deficiency as a consequence of a monitoring board reviewed the safety data on an
depletion of iron stores or defective iron absorp- ongoing basis. The authors had access to the study
tion and the reduced availability of iron recycled data and vouch for the accuracy and completeness
in the reticuloendothelial system.14,15 Four small of the reported data and analyses.
studies showed that the correction of iron defi-
ciency with the use of intravenous iron in pa- Recruitment and Follow-up of Study Patients
tients with chronic heart failure may result in Eligible subjects included ambulatory patients who
clinical benefits.16-19 In one of these studies,17 had chronic heart failure of New York Heart As-
the symptomatic benefit was similar in patients sociation (NYHA) class II or III, a left ventricular
with anemia and those without anemia. We de- ejection fraction of 40% or less (for patients in
signed our randomized, double-blind study, called NYHA class II) or 45% or less (for patients in
the Ferinject Assessment in Patients with Iron NYHA class III), a hemoglobin level at the screen-
Deficiency and Chronic Heart Failure (FAIR-HF) ing visit between 95 and 135 g per liter, and iron
trial, to determine whether the correction of iron deficiency. The presence or absence of iron defi-
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The n e w e ng l a n d j o u r na l of m e dic i n e
ciency was determined on the basis of results re- tion was less than 20%. Patients were excluded if
ceived from the central laboratory. Iron deficien- they had uncontrolled hypertension, other clini-
cy was diagnosed when the serum ferritin level cally significant heart disease, inflammation, or
was less than 100 g per liter or was between 100 clinically significantly impaired liver or renal
and 299 g per liter when the transferrin satura- function.
Table 1. Baseline Demographic and Clinical Characteristics of the Study Patients in the Intention-to-Treat Population,
According to Study Group.*
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Ferric Carboxymaltose in Heart Failure and Iron Deficiency
Table 1. (Continued.)
* Plusminus values are means SD. To convert the values for creatinine to micromoles per liter, multiply by 88.4. ACE
denotes angiotensin-converting enzyme, ARB angiotensin-receptor blocker, and NYHA New York Heart Association.
Race was self-reported.
The body-mass index is the weight in kilograms divided by the square of the height in meters.
The percent transferrin saturation was calculated as iron (in micromoles per liter)transferrin (in grams per li-
ter)25.1.
The estimated glomerular filtration rate was calculated by the central laboratory according to the Modification of Diet in
Renal Disease formula: 186(serum creatinine [in micromoles per liter]88.4)1.154age (in years)0.2031.21 (if pa-
tient is black)0.742 (if patient is female).
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The n e w e ng l a n d j o u r na l of m e dic i n e
Downloaded from www.nejm.org on January 6, 2010 . Copyright 2009 Massachusetts Medical Society. All rights reserved.
Ferric Carboxymaltose in Heart Failure and Iron Deficiency
40
34 35
Patients (%)
30 28
26
20 17 18
16
10
10
2 3 3 2 2 3
1 1
0
d
pr ly
pr tle
wo ly
ed
ed
ed
e
pr h
rs
rs
ge
ea
rs
im rate
e
im uc
im lit
at
ov
ov
ov
wo
wo
D
an
M
er
A
e
ch
le
h
od
od
uc
t
Un
lit
M
M
A
No. of Patients
Ferric carboxymaltose 47 100 77 54 5 2 2 5
Placebo 15 26 41 52 4 4 3 4
70
65
60
50
50 Ferric carboxymaltose
Patients (%)
41 Placebo
40
30 29
20
10
6
1 1 3 2 3
0
sI
II
d
sI
sI
ea
sI
as
as
as
D
as
Cl
Cl
Cl
Cl
No. of Patients
Ferric carboxymaltose 17 121 148 3 5
Placebo 2 43 97 4 4
class V and a missing self-reported Patient Global for interaction were performed as part of the sub-
Assessment was assigned as died.Anker
AUTHOR: The analysis group analysis RETAKE: regarding
1st the primary end points
2nd
regarding the primary end points was
FIGURE: 1 of 3 restricted by adding an interaction
3rd
term to the ordered poly-
to data for patients who had at least one valid tomous regression Revised model. Cox proportional-haz-
ARTIST: MRL
self-reported Patient Global Assessment or NYHA ards regressionSIZE models were used to estimate the
6 col
value, respectively, during theTYPE: Line period.
follow-up Combo 4-C
hazard H/Tratios for
33p9safety outcomes on the basis of
For the continuous variables, changes fromAUTHOR,thePLEASE
theNOTE:
treatment received. Event rates are reported
Figure has been redrawn and type has been reset.
baseline value and values at weeks 4, 12, and 24 per person-year at risk. All analyses were con-
Please check carefully.
were compared between the ferric carboxymaltose ducted with the use of SAS software, version 9.1
JOB: 36125 ISSUE: 12-17-09
group and the placebo group by comparing the (SAS Institute).
means within each of the two study groups at
each visit with the use of a model for repeated R e sult s
measures adjusted for baseline values. For cate-
gorical end points, differences in the distribution Characteristics of the Study Patients
for each of the two study groups were tested by The clinical characteristics of 459 patients are pre-
means of ordered polytomous regression. Tests sented in Table 1. A total of 304 patients were ran-
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The n e w e ng l a n d j o u r na l of m e dic i n e
Downloaded from www.nejm.org on January 6, 2010 . Copyright 2009 Massachusetts Medical Society. All rights reserved.
Ferric Carboxymaltose in Heart Failure and Iron Deficiency
FCM Better
FCM Better
Odds Ratio (95% CI)
2.0 2.0
1.0 1.0
Placebo
Placebo
Better
Better
0.5 0.5
0.0 0.0
0 4 8 12 16 20 24 0 4 8 12 16 20 24
Weeks since Randomization Weeks since Randomization
No. of Patients No. of Patients
FCM 282 291 292 FCM 304 287 294 294
Placebo 146 149 149 Placebo 155 147 150 150
FCM 10 FCM
Change in Score
30
8
20 6
Placebo 4 Placebo
10
2
0
0
10 2
0 4 8 12 16 20 24 0 4 8 12 16 20 24
Weeks since Randomization Weeks since Randomization
FCM FCM
No. of patients 303 284 280 268 No. of patients 295 274 283 285
Mean 2746 2947 3126 3137 Mean 541 601 621 631
distance (m) score
Placebo Placebo
No. of patients 155 144 141 134 No. of patients 152 140 145 146
Mean 2699 26910 27210 27710 Mean 541 542 562 572
distance (m) score
Mean Study-Treatment 216 377 358 Mean Study-Treatment 61 62 72
Effect Effect
E Kansas City Cardiomyopathy Questionnaire
14 P<0.001 P<0.001 P<0.001
12
Change in Overall Score
FCM
10
6 Placebo
0
0 4 8 12 16 20 24
Weeks since Randomization
FCM
No. of patients 297 277 286 286
Mean 521 621 651 661
score
Placebo
No. of patients 151 140 144 145
Mean 531 562 572 592
score
Mean Study-Treatment 61 82 72
Effect
Figure 3. Self-Reported Patient Global Assessment and New York Heart Association (NYHA) Functional Class in Predefined Subgroups,
AUTHOR: Anker RETAKE: 1st
According to Assigned Study Treatment. 2nd
The number of patients in each subgroup FIGURE:
for whom3 ofdata
3 were available is shown. The odds ratios 3rd are given for the ferric carboxymaltose
Revised
group, as compared with the placebo group, on a log
ARTIST: MRL 2 scale. For the results regarding the NYHA functional class in the subgroup of pa-
tients with heart failure of NYHA class II, one patient receiving ferric carboxymaltose had SIZEimprovement to NYHA class I and two pa-
7 col
tients receiving placebo had a worsening to NYHA Line III. Combo
TYPE: class 4-C
The body-mass H/T
index (BMI) is the weight in kilograms divided by the square
36p6
of the height in meters. CI denotes confidence interval, GFR glomerular
AUTHOR, PLEASEfiltration
NOTE: rate, and LV left ventricular.
Figure has been redrawn and type has been reset.
Please check carefully.
patients assigned to receive ferric carboxymaltose uration, and hemoglobin at week 24 were signifi-
and in 14 (9.0%) of the 155 patients assigned to cantly different between the two study groups
receive placebo. No severe allergic reactions re- (P<0.001 for all comparisons) (Table 3). The mean
lated to the study treatment were reported. Of (SE) difference in the ferritin level (adjusted for
the patients treated with ferric carboxymaltose, baseline) between patients receiving ferric car-
injection-site discoloration was reported for four boxymaltose and those receiving placebo was
patients and injection-site pain for two patients. 24317 g per liter at week 4, 18815 g per liter
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Ferric Carboxymaltose in Heart Failure and Iron Deficiency
Table 2. Safety End Points and Serious and Nonserious Adverse Events, According to Study Treatment Received.*
* Adverse events are classified on the basis of the system organ classes of the Medical Dictionary for Regulatory Activities. Events that were re-
ported in more than 4% of all the study patients are listed here. One patient who had been randomly assigned to the placebo group re-
ceived ferric carboxymaltose.
at week 12, and 24620 g per liter at week 24 difference in estimated glomerular filtration rate
(P<0.001 for all comparisons). The corresponding (adjusted for baseline) between patients receiving
mean differences in the hemoglobin level were ferric carboxymaltose and those receiving placebo
6.61.1, 10.61.3, and 5.91.5 g per liter, respec- was 3.81.8 ml per minute (P=0.03). There were
tively (P<0.001 for all comparisons), and the cor- no significant differences between the two study
responding mean differences in the mean corpus- groups with respect to adverse-event reporting
cular volume of erythrocytes were 1.50.4, 2.40.5, based on chemical values and other hematologic
and 2.70.7 m3, respectively (all P<0.001). The laboratory test results.
mean difference in the hemoglobin level at week
24 (adjusted for baseline) between the ferric car- Discussion
boxymaltose group and the placebo group was not
significant among patients who did not have ane- Treatment with ferric carboxymaltose for 24 weeks
mia at baseline (2.42.0 g per liter, P=0.21) but in patients who had chronic heart failure and iron
was significant among patients who had anemia deficiency with or without anemia improved symp-
at baseline (9.12.2 g per liter, P<0.001). The mean toms, functional capacity, and the quality of life.
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The n e w e ng l a n d j o u r na l of m e dic i n e
Table 3. Levels of Iron-Metabolism Markers and Hemoglobin at Week 24 According to Study Treatment.*
* Plusminus values are means SE. The P value is for the mean treatment effect, adjusted for the baseline value. One
patient who had been randomly assigned to the placebo group received ferric carboxymaltose.
The percent transferrin saturation was calculated as iron (in micromoles per liter)transferrin (in grams per li-
ter)25.1.
Our study also showed that treatment with ferric practice to decide whether symptom management,
carboxymaltose was not associated with an un- by means of treatment with intravenous iron, is
acceptable side-effect or adverse-event profile. indicated.
Our study showed improvement with ferric The dose needed to correct iron deficiency was
carboxymaltose in the two primary end points: calculated according to Ganzonis formula21 and
the self-reported Patient Global Assessment and was provided over a period between 3 and 7 weeks
the NYHA class at 24 weeks. The benefit was evi- (a median of six injections) during the correction
dent after 4 weeks and was maintained through- phase. We required that iron was given in doses
out the study period. These results were consistent of 200 mg per application and that the dosing
across all prespecified subgroups and were con- frequency was weekly during the correction phase
firmed by the observed improvements in distance and monthly during the maintenance phase. The
on the 6-minute walk test distance and in scores results of our study are applicable only to this
on the health-related quality-of-life questionnaires. dosing regimen. Treatment approaches involv-
Our patient population was identified on the ing higher doses and higher ferritin thresholds
basis of laboratory biomarkers, ferritin, transfer- for the interruption of therapy are untested in
rin saturation, and hemoglobin. These variables patients with heart failure.
were also used to calculate the iron-repletion dose The treatment with ferric carboxymaltose was
and to guide decisions about continuation or in- beneficial to both patients with anemia and those
terruption of ferric carboxymaltose. In that sense, without anemia. This suggests that iron deficiency
the trial is a double-blind treatment trial that used is a valid independent therapeutic target. Iron me-
guidance based on blood-sample data for study- tabolism in patients with chronic illness merits a
treatment initiation and monitoring. The study more detailed investigation to unravel the reasons
results suggest that in the assessment of ambu- why the correction of iron deficiency can result
latory patients with symptomatic heart failure and in symptomatic improvements even in the absence
systolic dysfunction, laboratory investigations to of a change in hemoglobin. Our results are con-
detect iron deficiency may be useful in routine sistent with those from four small studies that
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Ferric Carboxymaltose in Heart Failure and Iron Deficiency
were performed with the use of a different prepa- The benefit was seen in patients with anemia and
ration of intravenous iron.16-19 One of these stud- in those without anemia.
ies15 recruited a subgroup of patients without Sponsored by Vifor Pharma.
Dr. Anker reports receiving lecture fees from Roche Pharma
anemia who had even higher hemoglobin levels and Teva; Drs. Anker, Comin Colet, Filippatos, Willenheimer,
than our patients (i.e., 125 to 145 g per liter). We Dickstein, Lscher, and Ponikowski, fees from Vifor Pharma as
do not know the limit of hemoglobin up to which members of the FAIR-HF Executive Committee; Drs. Anker, Wil-
lenheimer, and Ponikowski, lecture and consulting fees from Vifor
iron deficiency is pathophysiologically important. Pharma and Amgen; and Dr. Willenheimer, lecture fees from Merck
On the basis of our current findings, we cannot and Servier; Dr. Kirwan reports being an employee of SOCAR Re-
recommend treatment with ferric carboxymaltose search, which received fees from Vifor Pharma; Drs. Mori and von
Eisenhart Rothe report being employees of Vifor Pharma and
for patients who have chronic heart failure, iron owning stock in Galenica; and Dr. Pocock reports receiving fees
deficiency, and a hemoglobin level above 135 g per from Vifor Pharma as the FAIR-HF consultant statistician. Finan-
liter, but such therapy is an area of interest for cial and other disclosures provided by the authors are available
with the full text of this article at NEJM.org.
future research. We thank the study coordinators, nurses, and staff at the in-
In conclusion, in stable, symptomatic, ambula- vestigative sites and especially all of the patients involved in the
tory patients with chronic heart failure, an im- FAIR-HF trial; Elena Malyshko (ClinStar) and Miriana Wennekes
(Kendle) and their study teams for study monitoring and manage-
paired left ventricular ejection fraction, and iron ment; Sophie De Brouwer (SOCAR Research) and Tim Clayton
deficiency, treatment with ferric carboxymaltose (London School of Hygiene and Tropical Medicine) for the statisti-
over a 24-week period improves symptoms, phys- cal analysis; and Nicola Waddingham and Giedrius Gaudesius
(Vifor Pharma) for overall study coordination. We dedicate this
ical performance, and the quality of life and has article to the memory of our colleagues Philip A. Poole-Wilson and
acceptable side-effect and adverse-event profiles. Helmut Drexler, who did not live to see the results of this trial.
Appendix
The members of the FAIR-HF study group are as follows: Executive Committee: S.D. Anker (chair), P. Ponikowski (cochair), K. Dickstein,
G.S. Filippatos, T.F. Lscher, R. Willenheimer, J. Comin Colet, H. Drexler (deceased), P.A. Poole-Wilson (deceased); and Data Safety and
Monitoring Board: R.P. Wthrich (chair), J. Lubsen. The FAIR-HF site investigators and institutions were as follows (with numbers of
recruited patients per country in parentheses): Argentina (6): J.H. Altamirano, Instituto de Investigaciones Cardiolgicas Prof. Dr. Al-
berto C. Taquini, Buenos Aires; S.V. Rodriguez, Instituto de Diagnstico Cardiovascular La Plata, Buenos Aires; Czech Republic (17): J.
pinar, Fakultn Nemocnice Brno, Brno; J. Povoln, Oblastn Nemocnice Kladno, Kladno; J. Blohlvek, Vseobecna Fakultn Nemocnice,
Prague; Z. Palch, Fakultn Thomayerova Nemocnice, Prague; J. Hork, Fakultn Nemocnice Kralovske Vinohrady, Prague; Germany (11):
S. Anker, Charit Berlin, Campus Virchow-Klinikum, Berlin; D. Wolf, CardioSec Clinical Research, Erfurt; M. Natour, Praxis Dr. M.
Natour und M. Durak, Heidelberg; Greece (11): A. Manolis, General Hospital of Voula Asklipion, Athens; J. Nanas, Alexandras General
Hospital, Athens; D.T. Kremastinos, University Hospital of Athens Attikon, Athens; D. Alexopoulos, University Hospital of Patras, Pa-
tras; Italy (11): M. Volterrani, Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele Pisana, Rome; G. Vescovo, Unit Locale
Socio Sanitaria 6 Ospedale San Bortolo, Vicenza; Norway (2): K. Dickstein, Stavanger Helseforskning, Stavanger; Poland (60): M. Mysli-
wiec, Wojewodzki Szpital Specjlaistyczny im K. Dluskiego, Biaystok; M. Ogorek, Samodzielny Szpital Wojewodzki im M. Kopernika,
Piotrkow Trybunalski; P. Staneta, Niepubliczny zakad Opieki Zdrowotnej Specjalistyczna Przychodnia Lekarska, Medikard, Plock; J.
Niegowska, Centrum Medyczne, Telmont Centrum Medyczne, Sp. z O.O., Warsaw; M. Duzniewski, Wojewdzki Szpital Brdnowski,
Warsaw; P. Ponikowski, 4 Wojskowy Szpital Kliniczny z Poliklinik, Wroclaw; L. Polonski, Slaskie Centrum Chorob Serca, Zabrze;
Romania (16): M. Radoi, Spitalul Clinic de Urgenta Brasov, Brasov; C.E. Macarie, Institutul de Boli Cardiovasculare Prof. Dr. C.C. Iliescu,
Bucharest; G.A. Dan, Spitalul Clinic Colentina, Bucharest; P.I. Kikeli, Societatea Civila Medicala Procardia Medical, Targu Mures; Russia
(200): E.S. Pasechnik, State Institution of Healthcare Kaluzhskaya Regional Hospital, Kaluga; A.A. Eremenko, Russian Scientific Center
of Surgery of the Russian Academy of Medical Sciences, Moscow; A.A. Gorbachenkov, Central Clinical Hospital of Civil Aviation of the
Ministry of Transport of the Russian Federation, Moscow; A.E. Bragina, City Clinical Hospital 61, Moscow; A.Y. Ivleva, Outpatient
Clinic 3 of President of the Russian Federation Administration, Moscow; B.Y. Bart, Russian State Medical University, Outpatient Diag-
nostic Consulting Center 1, Moscow; G.P. Arutyunov, City Clinical Hospital 4, Moscow; R.A. Khokhlov, Voronezhsky Regional Hospi-
tal 1, Voronezh; S.N. Tereschenko, Moscow State Medicine and Dentistry University of the Federal Agency for Health Care and Social
Development, Moscow; V.A. Lusov, Russian State Medical University, Moscow; V.N. Ardashev, Main Military Clinical Hospital, Moscow;
V.Y. Mareev, Cardiology Research Complex, Moscow; Z.D. Kobalava, Russian State People Friendship University, Moscow; O.P. Alexe-
eva, City Hospital 33, Nizhny Novgorod; V.E. Oleynikov, State Institution of Healthcare Regional Clinical Hospital, Penza; N.A. Kozi-
olova, Permsky Regional Hospital of War Veterans, Perm; D.V. Duplyakov, State Institute of Healthcare Regional Cardiology Dispen-
sary of Samara, Samara; A.A. Petrov, Leningrad Regional Clinical Hospital, St. Petersburg; D.U. Butko, International Clinic and Hospi-
tal Medem, St. Petersburg; M.Y. Sitnikova, Research Institute of Cardiology, St. Petersburg; O.A. Berkovich, St. Petersburg State Medical
University, St. Petersburg; S.A. Boldueva, St. Petersburg State Medical Academy, St. Petersburg; S.R. Minkin, City ConsultiveDiagnos-
tical Center 1, St. Petersburg; V.A. Kostenko, St. Petersburg Scientific Research Institute for Emergency, St. Petersburg; Y.G. Shvarts,
Saratov State Medical University of Roszdrav, Saratov; Y.B. Karpov, Voronezhsky Hospital of Emergency 1, Voronezh; S.V. Nedogoda,
Regional Clinical Hospital of Volgograd, Volgograd; Spain (22): J. Bruguera, Hospital del Mar, Barcelona; J. Gonzlez Costell, Hospital
Universitari de Bellvitge, Barcelona; M. Martnez Sells, Hospital General Universitario Gregorio Maraon, Madrid; J. Quiles Granado,
Hospital Universitario San Juan de Alicante, San Juan de Alicante; Ukraine (103): O.A. Koval, Dnipropetrovsk State Medical Academy,
Hospital Therapy 2, Dnipropetrovsk; G.A. Ignatenko, Donetsk State Medical University, Donetsk; I.G. Kraiz, Central Clinical Hospital
of Ukrzaliznitsya, Kharkiv; O.V. Prohorov, City Clinical Hospital 27, Kharkiv; V.I. Tseluyko, Kharkiv Medical Academy of Postgraduate
Education, Kharkiv; O.M. Parkhomenko, National Scientific Center Institute of Cardiology Academician Strazheska, Kiev; K.M. Amos-
ova, National Medical University, Kiev; L.V. Rudenko, Clinical Hospital of Emergency Medical Service, Kiev; O.M. Gyrina, National
Downloaded from www.nejm.org on January 6, 2010 . Copyright 2009 Massachusetts Medical Society. All rights reserved.
Ferric Carboxymaltose in Heart Failure and Iron Deficiency
Medical University, Kiev; V.Y. Lishnevska, Institute of Gerontology of the Academy of Medical Science of Ukraine, Kiev; S.S. Pavlyk,
Regional State Clinical Treatment-and-Diagnostic Cardiology Center, Lviv; I.P. Kovalsky, City Hospital 1 of Mykolayiv, Mykolayiv; G.S.
Popik, Odessa State Medical University, Odessa; Z.Y. Telyatnikova, Municipal Institution, City Policlinic 20, Odessa; I.V. Chopey, Uzhgorod
National University, Uzhgorod; V.A. Vizir, Zaporizhzhya State Medical University, Zaporizhzhya.
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