Abstract 18454: Temporal Trends in Assessment and Management of Iron Status in Patients With Heart Failure: A Multi-Institutional Study

Abstract

Background: Over the last decade there has been extensive investigation of iron deficiency in heart failure (HF). HFrEF patients are often refractory to oral iron supplementation whereas intravenous (IV) iron repletion has been shown to improve functional capacity, prompting a Class II guideline recommendation to assess iron stores and replete iron intravenously. The purpose of this study is to understand temporal patterns in assessment of iron status as well as utilization of oral and IV iron preparations in patients with HF. Methods: The Mass General Brigham (MGB) Research Patient Data Registry (RPDR) was used to conduct a retrospective analysis of patients with both HFrEF and HFpEF across 3 1-year intervals in 2012, 2017, and 2022. Circulating levels of iron, ferritin, and transferrin saturation (TSAT) were assessed. Patients were further classified according to the HF guideline-based definition of iron deficiency (ferritin <100 ng/mL or 100-299 ng/mL with a TSAT < 20%). Iron deficient (ID) HF patients were assessed for use and frequency of IV iron or oral iron for repletion. Results: Electronic health records within the MGB Healthcare System identified 23,687 total HF patients in 2012, 25,271 in 2017, and 36,059 in 2022. Among these patients, the percentage with iron studies measured within the calendar year were 48%, 62%, and 90% respectively. Of those with HF 5,557 (23%), 8,460 (33%), and 19,955 (55%) met guideline-based diagnostic criteria for iron deficiency. Oral iron supplements were used in 68%, 44%, and 19% of all ID HF patients. IV iron was given to only 4%, 11%, and 14% of ID patients ( Figure ). Conclusion: The temporal trends of iron assessment and repletion demonstrate a significant increase in assessment of iron stores by health care providers but persistent utilization of oral formulations in excess of IV formulations to treat ID. These data suggest a significant gap in implementation of a therapy associated with functional improvement in HF.