(P114) PUMPING IRON: A QUALITY IMPROVEMENT STUDY FOR THE TREATMENT OF IRON DEFICIENCY ANEMIA IN AMBULATORY HEART FAILURE PATIENTS

Background: Iron deficiency anemia (IDA) is a common comorbidity in patients with heart failure (HF) with reduced ejection fraction (HFrEF). It affects up to 50% of all ambulatory HF patients, and is associated with reduced functional class, exercise capacity, and quality of life (QoL). It has also been identified as an independent prognostic factor for mortality. The CCS 2017 Guidelines reflect the importance of IV iron supplementation in HFrEF patients with IDA to improve exercise tolerance, QoL, and to reduce HF hospitalization. Despite these recommendations, Canadian data on the management of IDA in ambulatory HFrEF patients are unavailable. The purpose of this study was to assess if a dedicated screening tool and treatment order set (Pumping Iron Bundle) could improve the diagnosis and treatment of IDA in ambulatory HFrEF patients at Sunnybrook Health Sciences Centre (SHSC).

METHODS AND RESULTS: We included HFrEF patients at the SHSC HF clinic in Toronto, Ontario, Canada between Jan.1/2018 and Oct. 27/2021 (pre-intervention cohort: Jan. 1/2018 – Jan. 1/2020; post-intervention cohort: Oct. 27/2020 – Oct. 27/2021) with HFrEF (LVEF ≤ 40%) and NYHA class I-IV symptoms. IDA was defined as hemoglobin < 130g/L and either ferritin < 100ng/mL, or ferritin 100-300 ng/mL and transferrin saturation < 20%. The intervention (Pumping Iron Bundle) was an IDA screening tool, treatment algorithm, order set, and patient information handout. Outcome measures were: (1) the proportion of HFrEF patients diagnosed with IDA pre- and post-intervention, and (2) the proportion of HFrEF patients with IDA treated with IV iron pre-and post-intervention. Proportion with IDA and proportion treated with IV iron pre- and post-intervention were compared using Chi-Square Tests of Independence. 379 patients were included in the study (249 pre-intervention, 130 post-intervention). Patient characteristics were similar in the pre- and post-intervention cohorts (age 68.5 ± 13.9 vs. 65.6 ± 15.5 years, male sex 78.7% vs. 65.3%, NYHA class III 20.9% vs 20%, respectively). There was a significant increase in the proportion of HFrEF patients that were identified with IDA for potential treatment with IV iron after the implementation of the Pumping Iron Bundle (pre-intervention = 36.3%, post-intervention = 90.1%; p < 0.001). In HFrEF patients with IDA who met criteria for IV iron, 90.3% in the post-intervention cohort were treated as compared to 17% in the pre-intervention cohort (p < 0.001).

Conclusion: The implementation of the Pumping Iron Bundle improved both the identification of HFrEF patients with IDA and their treatment with IV iron.