Background Iron deficiency anaemia is a frequent finding in adults with heart failure (HF). The prevalence varying depending upon the population studied.1,2 The recent FAIR-HF trial, demonstrates the importance of iron metabolism in patients with HF.3 Moreover, that a work-up evaluation for absolute or functional iron deficiency should be considered, and implementation of IV iron replacement for symptomatic improvement.
In this audit we wish to evaluate the prevalence of anaemia and iron deficiency in our unit
Method This was a prospective single centre audit between 21 October and 18 November 2014. The cycle was repeated between 26 March and 26 April 2015.
The audit standard was the WHO definition of anaemia.
Results Part 1: Demographics
During cycle 1
Population: 86 patients were worked up for anaemia and iron deficiency.
The average follow up time in Heart Failure Unit was 19.6 months
There were more males than females in our population. Only one female patient is still menstruating.
74% of our population are HfREF (n = 64) versus 26% HfPEF (n = 22).
During cycle 2
Population: 56 patients were worked up for anaemia and iron deficiency.
The average follow up time in Heart Failure Unit was 20.4 months. There were more males than females in our population. 57% of our population are HfREF (n = 31) versus 43% HfPEF (n = 23).
Part 2: Prevalence and incidence
The prevalence of anaemia in our cohort was 48% during cycle 1 and 64.8% during cycle 2. Previous studies have found that the incidence of anaemia appears to increase with worsening functional class (from 9% for NYHA class I to 79% for class IV in one report).4,5 We found no association between the incidence of anaemia for NYHA, BNP or EF in our cohort.
Part 3: Haematinic Screen
Haematinic screens were not routinely ordered on all anaemic patients during cycle 1. No haematinic screen was found for 15 anaemic patients, an incomplete screen was carried out on 9 anaemic patients and a complete anaemic screen on 17 patient. A complete haematinic screen was carried out on 8 patients with normal Hb levels. Iron deficency was detected in 17 patients. Five patient with iron deficency were noted to have a normal Hb level.
During cycle 2 and implementation of a routine strategy of a haematinic screening at initial programme visit or at annual review, if no such screen were on record, all patients had a haematinic screen.
Summary Iron deficiency management is not incorporated in the current ESC HF guidelines.6 However, recent studies have raised interest in the importance in symptomatic and QUAL in of HfREF patients, and experts anticipate it’s inclusion in future guidelines. Further given that there are few treatment strategies for HfPEF patients, management of iron deficiency in this cohort would be an area of interest to access any symptomatic and other clinical benefit. In this audit we successfully implemented a strategy of routine screening for iron deficiency, to capture all patients in both HfREF and HfPEF patients.
Importantly, at present our cohort our stable from a heart failure perspective. In future direction and management of these patients we aim to implement a strategy of IV iron replacement based on recent FAIR-HF and CONFIRM-HF studies.3,7
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