Quality Improvement Initiative to Improve Screening and Diagnosis Rates of Iron Deficiency in Patients Hospitalized for Acute Heart Failure With Reduced Ejection Fraction

Introduction: Despite being associated with reduced exercise capacity and poor quality of life in HFrEF, iron deficiency (ID) is underdiagnosed and undertreated. The 2022 ACC/AHA guidelines define ID in HFrEF as either a serum ferritin level < 100 ng/ml or 100-299 ng/ml with transferrin saturation (TSAT) <20 %. Treatment with IV iron is associated with a reduced risk of hospitalizations for HFrEF. A review of 20 inpatient acute HFrEF records revealed 10 had iron studies ordered, and 9 of them met criteria for ID, but only 1 patient received IV iron. Aim statement: To improve the testing rates for ID in hospitalized acute HFrEF patients at our hospital by 10% from January through March 2023. Methods: QI project included the implementation of an electronic health record (EHR) alert (Fig. 1) and resident education. The EHR alert was designed to be activated at the time of admission for patients with specific ICD codes for acute HFrEF to aid in ordering iron studies. A 20-minute educational session was delivered to residents, and handouts were provided to residents with reference material. Results: Pre-intervention data from January-December 2022 revealed a testing rate of 68% (154/194). ID was present in 58% (113/194). Post-intervention data from January 2023-March 2023 showed an improvement in the testing rate to 91% (67/73) and a concurrent increase in the diagnosis rate to 72% (53/73) (Fig. 2). Before discharge, 43.4% of patients (23/53) with ID received IV iron sucrose. Conclusion: Education and implementation of EHR alert were successful in increasing the testing rates for ID in acute HFrEF irrespective of anemia status. EHR tools should enhance sustainability compared to education alone.