Iron Supplementation in Patients with Heart Failure with Reduced Ejection Fraction Following Pharmacist-Led Review
Lauren Finn, Rachel Kile
CHI Memorial Hospital, Chattanooga, TN
Background/Purpose: Heart failure is a leading cause of hospitalization for patients older than 65, requiring proper management during inpatient stays. Iron deficiency is common in heart failure with reduced ejection fraction (HFrEF) and negatively impacts patient outcomes. This project aims to describe the impact of pharmacist intervention on the appropriate initiation of iron supplementation in patients with HFrEF, highlighting the pharmacist's role in optimizing HFrEF management.
Methods: This is a single-center, IRB-approved, quasi-experimental study. We conducted a retrospective chart review comparing the proportion of iron-deficient inpatients with an active diagnosis of chronic systolic heart failure who were appropriately initiated on intravenous iron therapy before and after the implementation of a pharmacist-led review process. Appropriate therapy was defined as a course of IV iron of at least 500 mg in iron-deficient patients. Eligible patients were at least 18 years of age with an ejection fraction of forty percent or less and with a ferritin <100 or ferritin between 100 and 300 and TSAT <20%. The primary endpoints analyzed were readmission rates at 30 and 60 days and the number of patients with appropriate iron therapy initiated. Secondary endpoints will include the number of pharmacist-initiated interventions for iron panels, ferritin levels, and iron supplementation. For both study arms, results will be reported with male and female participants combined, as well as sex disaggregated.
Results: There were not statistically significant differences in age, sex, race, or left ventricular ejection fraction between the pre-intervention and post-intervention groups. Additionally, there was not a statistically significant difference in the type of iron administered, and more patients received sodium ferric gluconate compared to iron dextran across both groups. Post-intervention, 39 patients were initiated on appropriate IV iron therapy as opposed to only 7 pre-intervention, This was a statistically significant difference with a p-value of 0.007. Differences in readmission rates at 30 & 60 days were not statistically significant between groups, but a lower percentage of patients was readmitted post-intervention. Of the 39 appropriate IV iron initiations post-intervention, 23 were pharmacist-initiated, with the remaining being provider-led. The number of pharmacist-initiated orders was 18 for iron panels and 21 for ferritin levels.
Conclusions: Pharmacist-led review significantly improved appropriate IV iron supplementation in patients with HFrEF. Considering that of the 39 patients initiated on appropriate IV iron therapy post-intervention, 23 orders were pharmacist-led, it can be concluded that providers are initiating IV iron therapy as well. Although results for readmission rates were not statistically significant, fewer patients were readmitted post-intervention. Orders for iron panels and ferritin levels were higher in the post-intervention group. Overall, these findings support pharmacist interventions in this patient population to improve adherence to guideline recommendations.
Contact:
[email protected]
