Iron Deficiency Anemia and Treatment in ​Heart Failure: A Novel Multidisciplinary Quality Improvement Project

Abstract

Background: Iron deficiency anemia (IDA) is an important contributor to the systemic disease process in heart failure (HF). Intravenous (IV) Iron repletion has been shown to be superior to oral iron repletion with respect to decreased side effect profile, improved quality of life, reduced mortality and rehospitalization in HF patients. No study has outlined a multidisciplinary hospital-based process in identifying and treating this specific cohort of patients with IV Iron repletion. Objectives: Our quality improvement (QI) initiative sought to identify patients with IDA and HF in real time and treat them with IV iron repletion instead of oral iron supplementation during their hospitalization using a multidisciplinary approach. Methods: Between May 2021 and February 2022, using a daily real time electronic medical record patient intake filter, we identified patients admitted for acute decompensated heart failure with a hemoglobin of less than or equal to 12g/dl. Patients were further analyzed for IDA via laboratory iron panel. In accordance with the European Society of Cardiology (ESC) guidelines, anemic patients with a ferritin <100 µg/L or ferritin of 100-299 µg/L with a transferrin saturation <20% qualified for IV Iron repletion. An IDA QI team was created consisting of internal medicine residents, advanced care practitioners, cardiology fellows, and pharmacists to educate providers, identify and treat qualified patients. Patients were treated with IV Iron Sucrose 300mg/day for three consecutive days. Results: 54 patients were included in the study with three outliers removed, 16 patients were given oral iron sulfate therapy and 36 received IV iron sucrose therapy. Heart failure with reduced ejection fraction was the predominant HF phenotype with 38 patients. The average hemoglobin of our cohort was 8.6 with a mean corpuscular volume of 90.2, ferritin of 98, serum iron of 26, TIBC of 253, and transferrin of 200. A statistically significant decrease in average hospital length of stay was noted in the IV iron repletion arm of 5 days versus 10 days in the oral repletion group (p <0.01). There was no statistically significant difference in length of stay among HF patients with varying levels of ferritin. Conclusion: Our quality improvement project successfully created a real time multidisciplinary approach to identifying and treating patients with IDA and HF. A statistically significant decrease in length of stay was associated with IV iron repletion. We increased the utilization of IV iron compared to oral repletion by more than 100% during the same time. As a result of this project, IV iron repletion is now a part of our armamentarium in holistically treating heart failure.