Abstract 4144883: Management of Iron Deficiency in Heart Population Treated in Heart Failure Unit and the Outlier Setting, A Comparison Study.

Background: Iron deficiency (ID) is common amongst patients with heart failure (HF). The European Society of Cardiology (ESC) guidelines recommends intravenous (IV) Iron supplementation in symptomatic HF patients with reduced left ventricular ejection fraction (LVEF) and ID to alleviate HF symptoms and improve quality of life. The current study aims to assess adherence to the latest ESC guidelines in treatment of ID in HF patients admitted to non-cardiac (outlier) wards at St. George's University Hospital (SGH), London. The results were compared to standard practice at a dedicated heart failure unit (HFU) at SGH. Methods: Retrospective data was collected on consecutive HF patients, admitted to SGH between September 2022 and September 2023. 386 patients met the inclusion criteria, defined as HF with LVEF < 50% and ID according to ESC guidelines. Of total population, 190/386 patients were admitted to the outlier wards and 196/386 to the HFU. Patients considered ineligible for administration of IV Iron therapy, were those not meeting the guideline thresholds for treatment of ID, patients with active cancer or bleeding and patients on oral Iron supplementation. Results: The mean age of patients admitted to HFU was 71 +/- 13 SD, 66% male. 72% (141/196) of the patients were tested for ID, of which 51% (72/141) had ID as per inclusion criteria. 57% (41/72) of those with ID were prescribed IV Iron, whilst 43% (31/72) were not treated. The reason for not treating patients identified as Iron deficient was presence of active infection (19/31) or bleeding (3/31). In 9/31 of untreated patients with ID, the reason for not being prescribed with IV Iron was not identifiable through review of medical notes. It is important to note that 28% (55/196) were not tested for ID during their hospitalisation and missed the opportunity for treatment. (Figure 1) In outlier wards, mean age was 77 +/- 14 SD, 66% male. 46% (87/190) patients were tested for ID, of which 16% (14/87) were identified as Iron deficient and were prescribed IV Iron. 4% (12/87) were not treated for no obvious reason and 18% (16/87) met the criteria for ID, but due to presence of contraindication did not receive IV Iron. Missed opportunity was 54% in outlier population. (Figure 2) Conclusion: This study demonstrated that patients admitted to HFU, were more likely to be tested for ID and receive IV Iron, compared to patients admitted to outlier wards but there is still room for considerable improvement in both settings.