{
  "abstract": "Introduction Iron deficiency anaemia (IDA) is common in patients with heart failure with reduced or mildly reduced ejection fraction (HFrEF/HFmrEF) and is associated with poorer functional status and adverse outcomes. 1 2 The ESC guidelines recommend screening for IDA and treatment with intravenous (IV) iron in symptomatic patients with HFrEF/HFmrEF and IDA to improve symptoms, quality of life, and reduce heart-failure-related hospitalisation.3 4This quality improvement project (QIP) aimed to improve awareness of, and compliance with, ESC guideline-directed screening and treatment of IDA in patients with HFrEF/HFmrEF admitted to Furness general hospital (FGH) and Royal Lancaster Infirmary (RLI) within University Hospitals of Morecambe Bay NHS Foundation Trust (UHMBT).Methods This was a two-cycle audit using the Plan-Do-Study-Act methodology. Adult inpatients admitted under the medical teams at both hospitals were included if they had HFrEF/HFmrEF (ejection fraction (EF) <50%). Patients with EF ≥50% or haemoglobin (Hb)>130 g/L in females or >140 g/L in males were excluded. Variables collected included EF, Hb, serum ferritin, transferrin saturation and use of IV iron therapy. The first audit cycle (May-July 2024; n=50) assessed baseline compliance with ESC guidelines. A multidisciplinary educational intervention was subsequently implemented including interactive teaching sessions, discussions at local audit meetings and educational posters in key clinical areas. A questionnaire assessed knowledge of the ESC guidance and willingness to change clinical practice. A second audit cycle (November 2024-January 2020; n=50) reassessed compliance.Results Baseline screening was low: ferritin was checked in 20% of patients, transferrin saturation in 14%, and both in 6%, and 6% received IV iron ( figure 1).Post-intervention questionnaires demonstrated improved clinician awareness, with 80% recognising IDA screening as important, 97% aware that iron studies should include both ferritin and transferrin saturation, 93% aware that IV iron is recommended in these patients, and 87% willing to implement this.In the second audit cycle, screening improved modestly for ferritin testing (20% to 34%) and combined ferritin/transferrin testing (6% to 10%). Transferrin saturation testing alone remained unchanged (14%), while compliance to ESC guideline–recommended IV iron treatment decreased slightly (6% to 4%) (figure 2).Conclusions Despite improved clinician awareness following targeted education, this QIP demonstrated only modest improvement in screening for IDA in patients with HFrEF/HFmrEF and anaemia. Barriers to adherence to ESC-recommended screening and treatment of IDA in this cohort of patients included winter infection burden, competing inpatient clinical priorities, lack of local protocols and limited outpatient capacity for IV iron administration. Local guidelines were implemented following the second cycle, and further re-audit may demonstrate improved and sustained compliance.References Graham FJ, et al. Treating iron deficiency in patients with heart failure: What, why, when, how, where and who. Heart 2024;110(20):1201–1207. doi:10.1136/heartjnl-2022-322030. Schupp T, et al. Effect of anaemia and iron deficiency in heart failure with mildly reduced ejection fraction. European Journal of Clinical Investigation 2024;54(8). doi:10.1111/eci.14205. McDonagh TA, et al. 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: developed by the task force for the diagnosis and treatment of acute and chronic heart failure of the European society of cardiology (ESC) with the special contribution of the heart failure association (HFA) of the ESC. European Heart Journal 21 September 2021;42(36):3610.McDonagh TA, et al. 2023 focused update of the 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: developed by the task force for the diagnosis and treatment of acute and chronic heart failure of the European society of cardiology (ESC) with the special contribution of the heart failure association (HFA) of the ESC. European Heart Journal 1 October 2023;44(37):3636–3637.Abstract 411 Figure 1Percentage of eligible patients who were screened and treated for IDA in cycle 1Abstract 411 Figure 2A comparison of the percentage of eligible patients in cycle 1 and cycle 2 who were screened and treated for IDA",
  "authors": [
    {
      "affiliations": [
        "University Hospitals of Morecambe Bay NHS foundation trust, Morecambe Bay, United Kingdom"
      ],
      "name": "S Ranjithkumar"
    },
    {
      "affiliations": [
        "University Hospitals of Morecambe Bay NHS foundation trust, Morecambe Bay, United Kingdom"
      ],
      "name": "CK Lim"
    }
  ],
  "title": "411 Identify and treat iron deficiency anaemia in HFrEF/HFmrEF patients",
  "uid": "5ed7aeea-08fb-51b3-97c1-120b0735d75c"
}