(VP125) UNDERUTILIZATION OF INTRAVENOUS IRON IN A CONTEMPORARY POPULATION OF AMBULATORY HEART FAILURE PATIENTS IN CANADA

Background: Intravenous iron has been shown to improve quality of life and exercise capacity in patients with heart failure and reduced ejection fraction (HFrEF) with iron deficiency anemia. There is lacking real world data to understand the use of intravenous (IV) iron in this population. Hence, we undertook this study to understand the utilization rates of IV iron in a Canadian heart function clinic.

METHODS AND RESULTS: This retrospective analysis was carried out on all heart failure (HF) patients referred to a tertiary care Heart Function Clinic (HFC) who would have been eligible for intravenous iron therapy from January 2020 until December 2022. Our inclusion and exclusion criteria were based on the FAIR HF trial. Inclusion criteria was left ventricular ejection fraction (LVEF) of ≤40% for patients with New York Heart Association (NYHA) class II or ≤45% for NYHA class III, hemoglobin level of 95 to 135 g/L, iron deficiency which was defined as a ferritin level < 100 μg/L, or a ferritin between 100 and 299 μg/L with a transferrin saturation < 20%. The data and decision to recommend IV iron was based on initial HFC consultation and pre-appointment investigations.

Out of 1360 charts reviewed, 920 patients had a complete data set in order to determine eligibility. Of those, 127 (13.8%) met IV iron eligibility criteria as per the FAIR HF trial. Of those eligible, 64.6% were male. HF etiology was 33.1% ischemic, 40.9% nonischemic, and 26.0% mixed/other (p=0.518). 98.4% had HFrEF and 1.6% had heart failure with mildly reduced ejection fraction (HFmrEF) (p < 0.001). The mean LVEF for those meeting criteria for IV iron was 28.3±7.6% vs 36.1±13.7% for those ineligible (p < 0.001). Mean NYHA class for those meeting criteria for IV iron was 2.3±0.5 vs 2.1±0.7 for those ineligible (p < 0.001). Only 3 (2.4%) of the eligible patients were recommended or received IV iron, while 2 (1.6%) others had received IV iron prior to HFC visit (Fig). There were no significant differences in the proportion of patients receiving optimal quadruple therapy HF management between both cohorts (p=0.07).

Conclusion: Our study demonstrates a significant underutilization of IV iron administration in eligible HFC patients, presenting many missed opportunities to improve patient quality of life. This analysis reveals opportunities to improve comprehensive HF patient care including strategies to complete pre-appointment investigation screening and to create a reliable system of IV iron administration.