IRONMAN – Effectiveness of intravenous iron treatment vs standard care in patients with heart failure and iron deficiency: a randomised, open-label multicentre trial.

Summary of the main results from IRONMAN

The IRONMAN trial, which was funded by the British Heart Foundation, looked at more than one thousand symptomatic patients with a type of heart failure where their ejection fraction (strength of heart muscle contraction) was reduced. Many patients were recruited from the community, rather than during acute hospital admissions, making them representative of people living with heart failure in the community. Patients, all of whom had low iron levels, were split into two groups, with one group receiving normal care, and the second group receiving normal care plus doses of intravenous (IV) iron (a drip into a vein). The progress of patients was followed for more than two and a half years on average.

As many patients will know, the COVID-19 pandemic upset a lot of the care given to patients. It was no different for people on the trial and for periods of time it was not possible for the research doctors and nurses to see patients in-person to check progress directly, to review iron levels and to re-dose with IV iron as necessary. As such analyses of the results to try and remove the impact of COVID-19 on the results were also performed.

The headline outcomes of the trial were that with IV iron:

  • The likelihood of being hospitalised because of heart failure was reduced
  • Quality of life (QoL) was improved at around 4 months
  • There were no signals of concern about safety

The results have been reviewed by international experts writing guidelines for clinicians and alongside other trial data around IV iron use in heart failure. These guidelines have been updated and IV iron is recommended for those patients who are iron deficient to help symptoms and reduce the risk of being admitted to hospital due to heart failure.

Record Linkage Process
Record linkage is the way that we receive data from centralised electronic databases regarding any hospital admissions, new diseases, prescribing records and deaths. It is important for us to receive this information as it helps us to identify important medical events affecting patients within the study such as admissions to hospital due to heart failure or heart attacks or strokes. Participants can withdraw consent for accessing medical records (including record-linkage) at any time by letting their IRONMAN nurse know.

In taking part in the IRONMAN study, participants consented to the research team following up their health status for up to 10 years after the end of the study using data supplied by the Information Services Division (ISD) of NHS Scotland and NHS Digital in England/Wales. We would like to update you on how we are currently using your data, what is involved in the process of record-linkage and to explain the involvement of NHS England (formerly known as NHS Digital).

The following information applies to IRONMAN study participants in Scotland:
The Health and Social Care Information Centre (HSCIC, now known as NHS England (formerly NHS Digital) was established in April 2013 and is responsible for providing a trusted Safe Haven for some of an individual's most sensitive health and social care information.

NHS England collects information from the records that health and social care providers keep about individuals using their services. The data is collected from a wide range of providers across England and Wales, ranging from hospitals to general practices.

One of the datasets collected is called Hospital Episode Statistics (HES). This is information about patients in relation to their NHS visits and stays at hospitals in England and Wales. The information collected contains details of admissions to hospital, outpatient appointments, and A&E attendances. We also will get death certification data.

We need to tell NHS England who you are, so that they can supply your records to us. We will supply your IRONMAN study participant number, NHS Number, date of birth, postcode, and name, and NHS England will return your hospital, cancer registration and mortality records to us identified by your unique IRONMAN study participant number only. All transfer of data is handled securely and confidentially, in line with NHS standards.

For further information about NHS England or HES data, please click on the links below:
Link to NHS England
Link for HES data

The following information applies to IRONMAN study participants in Scotland:
In Scotland, specific departments within the health service collect information from the records that care providers keep about individuals using their services. The data are collected from a wide range of providers across Scotland, ranging from hospitals to general practices. In Scotland from the organisation holding the data is called Public Health Scotland.

One of the datasets collected is related to hospital admissions. This is information about patients in relation to their NHS visits and stays in hospitals. The information collected contains details of admissions to hospital, outpatient appointments, and A&E attendances. We will also get death certification data.

In order that they can supply your records to us we will supply them with your IRONMAN study participant number and Community Health Index number, and Public Health Scotland will return your hospital and mortality records to us identified by your unique IRONMAN study participant number only. All transfer of data is handled securely and confidentially, in line with NHS standards.

For further information about Public Health Scotland please click on the link below:

Public Health Scotland

Data Management for the study – Robertson Centre for Biostatistics, University of Glasgow
The Robertson Centre for Biostatistics, University of Glasgow, acts as the data processing centre and as such are responsible for the storage, data management and processing of the data relating to the IRONMAN study. The Robertson Centre is an ISO27001 (security certificate) approved academic unit within the University of Glasgow that has extensive experience in handling patient data for clinical trials and undergoes regular audits and inspections. The data relating to the IRONMAN study will be stored and analysed at the University of Glasgow in accordance with approved study procedures. This collaboration is described in the study protocol and has been included in all relevant approvals, such as approval by a national ethics committee. The Robertson Centre is regarded as part of the IRONMAN study team.

If you would like to discuss any of what is described above, please contact the study team using the contact details on this website.

General Data Protection Regulation (GDPR) information
NHS Greater Glasgow & Clyde and the University of Glasgow are the sponsors for this study based in the United Kingdom.

How will we use information about you?

We will need to use information from you, from your medical records, from your GP and from national databases for this research project.

This information will include your initials/NHS or CHI number/name/contact details. People will use this information to do the research or to check your records to make sure that the research is being done properly.

People who do not need to know who you are will not be able to see your name or contact details. Your data will have a code number instead.

We will keep all information about you safe and secure.

In future, some of your information may be sent to other countries. They must follow our rules about keeping your information safe. No personal data will be shared.

Once we have finished the study, we will keep some of the data so we can check the results. We will write our reports in a way that no-one can work out that you took part in the study.

What are your choices about how your information is used?

  • You can stop being part of the study at any time, without giving a reason, but we will keep information about you that we already have.
  • If you choose to stop taking part in the study, we would like to continue collecting information about your health from central NHS records/your hospital/your GP. If you do not want this to happen, tell us and we will stop.
  • We need to manage your records in specific ways for the research to be reliable. This means that we won’t be able to let you see or change the data we hold about you.
  • If you have consented to having samples taken for use in this and future ethically approved studies these will be labelled with a code and stored within a biobank at the University of Leicester.

Where can you find out more about how your information is used?

You can find out more about how we use your information

Data Protection Officer
NHS Greater Glasgow and Clyde
1 Smithhills Street
Paisley
PA1 1EB

PRIVACY NOTICE
The privacy notice can be viewed here

The supplemental privacy notice can be viewed here

CONTACT
If you have any questions about the IRONMAN Study please contact the Trial Manager, Lizzie Thomson – Elizabeth.Thomson@glasgow.ac.uk