Abstract 8143: Prevalence of Iron Deficiency Screening in Patients with Acute Myocardial Infarction Who Develop Hospital-Acquired Anemia

Abstract

Background: Hospital-acquired anemia (HAA), a new onset anemia in patients with normal admission hemoglobin (Hgb), is common, frequently develops in the absence of overt bleeding, and is associated with poor outcomes in acute myocardial infarction (AMI) patients. Iron deficiency may be an underlying modifiable risk factor for HAA, but the prevalence of iron deficiency screening and the frequency of iron deficiency is unknown in AMI patients. Methods: We studied 17676 AMI patients from 57 US hospitals in the Health Facts database who were not anemic at admission. HAA was defined as a nadir Hgb below age, gender and race specific thresholds and moderate-severe HAA was defined as nadir Hgb < 11 g/dl. All laboratory tests obtained and all in-hospital medications were recorded from the electronic medical record. We identified the proportion with and without HAA who had any laboratory evaluation of iron stores (ferritin, serum iron or iron binding capacity), and the frequency of iron deficiency among those who were tested (using established thresholds for patients with comorbid heart failure and kidney disease of a ferritin < 100 ng/ml or between 100 and 299 when transferrin saturation was <20% and a ferritin of < 45 ng/ml for all other patients). Results: Both mild (n=6615, 37%) and moderate-severe HAA (n=3551, 20%) were common. Assessment of iron stores was rare in all groups, but increased with greater HAA severity (no HAA: 52 (0.7%), mild HAA: 117 (2%) and moderate-severe HAA: 364 (10%), p<0.001). Among patients who had iron testing, iron deficiency was common regardless of HAA status (no HAA: 14/52 (27%), mild HAA: 24/117 (21%) and moderate-severe HAA (106/364 (29%), p=0.24). Few iron deficient patients received in-hospital iron supplementation (no HAA: 0/14, mild HAA: 2/24 (8%) and moderate-severe HAA: 16/106 (15%), p=0.25). Conclusions: Testing for iron deficiency is rare in AMI patients and is only slightly more common in those who develop HAA. Although only a select fraction of patients were screened, iron deficiency was common in these patients, and was infrequently treated. Studies are needed to determine the prevalence of iron deficiency in AMI patients with HAA and whether diagnosing and treating iron deficiency in AMI patients with HAA improves outcomes.