Iron Deficiency Screening and Treatment in Hospitalized HFrEF Patients: A Quality Improvement Initiative

Iron deficiency affects up to half of patients with heart failure and is associated with worse symptoms, quality of life, and clinical outcomes, even in the absence of anemia. Contemporary guidelines recommend routine screening and intravenous (IV) iron therapy for eligible patients with heart failure with reduced ejection fraction (HFrEF), yet real-world adoption remains limited.

Given persistently low screening and treatment rates, we sought to improve inpatient iron deficiency screening and IV iron use among patients hospitalized with acute HFrEF at a community teaching hospital.

We implemented a multifaceted quality-improvement intervention incorporating an IV iron order set, targeted provider education, and unit-based visual reminders. Compared with a 6-month preintervention period, iron deficiency screening increased from 28.7% to 40.6%, and overall IV iron use more than doubled from 8.5% to 17.5%.

System-based interventions can meaningfully improve the delivery of guideline-directed care in hospitalized heart failure patients. Continued efforts are needed to address remaining gaps and ensure sustained adoption of these guidelines.