Abstract 18608: Using Electronic Medical Record Based Tools to Assess the Prevalence of Iron Deficiency, Iron Deficiency Anemia, and Treatment With IV Iron Among Patients With Decompensated Heart Failure

Introduction: Iron deficiency (ID) and iron deficiency anemia (IDA) are common among patients with heart failure (HF). They are associated with increased hospitalizations and all-cause mortality. Intravenous (IV) iron repletion has been associated with significant improvement in these outcomes, but is underutilized during HF admissions. Electronic medical record (EMR) based tools to increase recognition of ID and IDA in patients with HF and promote treatment with IV iron have not been described.

We developed an EMR based tool to identify patients admitted with HF with ID and IDA who were candidates for IV iron repletion in an urban academic medical center.

Hypothesis: ID and IDA are underdiagnosed and undertreated among patients admitted for HF. EMR based tools can be used to systematically identify patients with ID, IDA, and increase appropriate use of IV iron in patients with HF.

Methods: Retrospective analysis of patients admitted with HF between March and May 2023. The EMR based tool defined HF by encounter diagnosis and use of IV diuretics, anemia by hgb of < 13 g/dl (male) and < 12 g/dl (female), ID by ferritin < 100 ng/ml or ferritin < 300 ng/ml and iron saturation < 20%, IDA by presence of ID and anemia, and if the patient received IV iron. Presence of HF, anemia, ID, IDA, and use of IV iron were confirmed by manual chart review.

Results: The EMR based tool identified 116 patients admitted with a diagnosis of HF who received IV diuretics. In total, 103 (89.6%) had clinically decompensated HF by chart review. Three patients were excluded due to leaving AMA or on hospice. The average patient age was 63.8 years, 49 (50%) were male, and 50 (50%) were female, and 72 (73%) were African American (AA). In this sample, 81 (82%) had anemia, of which 47 (58%) had both ferritin and iron saturation levels collected during the admission. A total of 15 (19%) had no record for ferritin, iron saturation, or both. By including labs from prior admissions, a total of 64 (65%) of the 99 patients had ID while 57 (58%) had IDA. In total, 22 received IV iron (34% of patients with ID, 39% of patients with IDA).

Conclusions: An EMR based tool can be used to identify patients with HF, ID, IDA, and the use of IV iron. ID and IDA are prevalent among patients with HF but remain underdiagnosed and undertreated.