Four-Year Evaluation of a Pharmacists-Providers Collaborative Iron Deficiency Clinic in Heart Failure Care

To evaluate the performance of the pharmacists-providers collaborative iron deficiency treatment clinic in the heart failure service.

A single-center retrospective cohort study was conducted to evaluate the performance of the iron deficiency pharmacists-providers collaborative care clinic during the induction and maintenance phases of intravenous (IV) iron therapy. The study included patients who were seen by HF providers (advanced HF cardiologists or advanced practice providers) and received the IV iron consultation with HF pharmacists. The study included patients aged 18 years or older who were diagnosed with HF or PH and received at least one dose of either ferric carboxymaltose or iron sucrose in outpatient settings. It was managed by the pharmacists-providers collaborative IV iron clinic. The primary outcome was adherence to the IV iron appropriate use criteria, laboratory requirements, and dosing during the induction course. The primary and secondary outcomes were compared with those of the previously reported control group, which received the usual iron deficiency treatment care at the HF clinic prior to the implementation of the pharmacists-providers collaborative IV iron deficiency treatment clinic. The use of oral iron therapy was evaluated over four years.

A total of 187 patients were included in the final cohort. The median follow-up period of the IV iron consulting team was 372 (176, 623) days. Compared to the pre-implementation group, the primary outcome was significantly higher in the post-implementation group (81.3 vs. 40%, p<0.001). The most common reasons for nonadherence were the absence of maintenance laboratory requirements (15.5%), failure to administer all induction doses (1.6%), inappropriate use (1.1%), and incorrect dose (0.5%). Ferritin, iron saturation, and hemoglobin values at cycle one were significantly increased after the IV iron induction course compared to baseline values and remained numerically stable throughout the follow-up periods. Serum phosphorus levels remained within the normal range throughout the follow-up period. Among 57 patients on oral iron therapy, the consulting team discontinued it in 19 patients (33.3%) during follow-up.

The pharmacists-providers collaborative IV iron clinic significantly improved the performance of IV iron therapy in rural heart failure care settings compared to the usual care. These results highlight the importance of multidisciplinary care management for iron deficiency in the real-world heart failure practice.