Beyond Detection: Iron Deficiency Screening and Treatment Gaps in Hospitalized Patients With HFrEF

Iron deficiency is a common comorbidity among patients with heart failure with reduced ejection fraction (HFrEF), and it remains under-recognized and undertreated despite contemporary guideline recommendations for intravenous iron therapy.

We sought to increase iron deficiency screening among hospitalized patients with HFrEF from a baseline of approximately 12% to >50% while identifying barriers to implementation of guideline-directed intravenous iron therapy.

A multiphase Plan-Do-Study-Act quality improvement initiative integrated an iron panel into the heart failure admission order set, provided targeted provider education, and subsequently developed a standardized intravenous iron replacement protocol for integration into the electronic health record. Among 441 hospitalized patients with HFrEF, screening increased to 64.6% (285/441). Iron deficiency was identified in 243 of 285 screened patients (85.3%), yet only 67 (27.6%) received intravenous iron therapy.

Improving screening alone is insufficient to optimize iron deficiency care in hospitalized patients with HFrEF. Closing the gap between diagnosis and treatment will require workflow-integrated strategies to facilitate implementation of guideline-directed intravenous iron therapy.