An audit of investigation and supplementation of iron deficiency in elderly and very-elderly acutely hospitalised heart failure patients.
S Elekes, A Cleary, S Cuddy, R Cawley, P Fox, R SheahanAbstract
Background
Iron deficiency Anaemia (IDA) is a common comorbidity, occurring in 40-70% of patients with heart failure (HF) and is known to negatively impact quality of life and mortality. Prevalence in those admitted with acute decompensated heart failure (ADHF) is higher than those with chronic HF. Periodic screening for iron deficiency and iron supplementation remains the standard of care in management of IDA as outlined in the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. IV replacement has been shown to improve clinical outcomes by reducing HF hospitalisations and cardiovascular mortality, with benefit proven in large outcome trials such as AFFIRM-AHF, IRONMAN and HEART-FID. Despite this, testing and treatment remain inconsistent and IDA continues to be underdiagnosed and undertreated, particularly in an inpatient Elderly setting where limited data exists.
Purpose
To assess our adherence to ESC guidelines of diagnosis and management of iron deficiency anaemia in elderly patients admitted with ADHF in an Irish Level 4 hospital.
Methods
Starting from 15 November 2025, 100 consecutive patients admitted with ADHF were identified and followed up through retrospective chart review. Eligible patients had clinical signs and symptoms of volume overload, raised NT-Pro-BNP and a clinician diagnosis of ADHF in the patient record. Patient demographics, comorbidities, biochemistry and echocardiographic data were collected and analysed using descriptive statistics. Appropriate identification of IDA and iron supplementation were recorded.
Results
Of 100 patients audited with ADHF, 31% (n=31) had a severely reduced EF. 53% were diagnosed with HFpEF. Baseline demographics summarised in Table 1 show a median age of 81 years. Anaemia was detected in 69% (n = 69) of patients in our cohort. Hematinic testing was performed in 61 patients. Of these, 17 (28% of those tested) were found to be iron deficient. Intravenous iron replacement was administered to 4 patients during their inpatient stay and a further 2 patients were scheduled to receive intravenous iron as in an outpatient setting. Median length of stay was 12 days. Inpatient mortality rate was 14%. Very-elderly age (>80) showed a trend for prolonged inpatient hospitalisation and inpatient mortality.
Conclusion
Our audit identifies IDA as a missed opportunity for intervention in elderly and very elderly patients recently hospitalised with ADHF. Screening for IDA and supplementation of iron stores were lower than expected in this elderly and very elderly inpatient groups. This highlights the necessity for physician education, dedicated early treatment pathways for inpatients and in an early outpatient setting.For image description, please refer to the figure legend and surrounding text.