Iron-DH: integrating intravenous iron therapy into a multidisciplinary, telemonitored heart failure pathway for frail older adults

Background

Iron deficiency (ID) is frequent in heart failure (HF) and is associated with poorer functional capacity, quality of life, and prognosis. Despite clear ESC recommendations for intravenous (IV) iron supplementation, real-world implementation remains inconsistent, particularly among frail older adults with multimorbidity and limited access to ambulatory care.

Purpose

To describe the design and early outcomes of a dedicated Cardiogeriatric Iron Day Hospital (Iron-DH) program—an organizational innovation integrating IV iron repletion within a multidisciplinary, telemonitored HF care pathway aimed at preventing avoidable readmissions.

Methods

Iron-DH delivers IV ferric carboxymaltose according to ESC guidelines, combined with comprehensive clinical, functional, and cognitive assessment. The program is embedded within a cardiogeriatric network linking day-hospital, telemonitoring, and community services.

Beyond IV therapy, Iron-DH acts as a structured follow-up unit where patients are clinically reassessed, medication regimens reviewed, and early signs of congestion detected to avoid full rehospitalization. Functional capacity is evaluated using the six-minute walk test (6MWT) and Kansas City Cardiomyopathy Questionnaire (KCCQ); cognition by the Clock Drawing Test. Re-evaluation occurs 4–6 months later, either in day-hospital or through telemonitoring follow-up.

Results

Between January and June 2025, 421 HF patients were hospitalized; 224 (53.2 %) had ID and 67 (29.9 %) were managed in Iron-DH. All received IV iron safely. Diuretics were adjusted in 34.3 %, and 20.9 % were redirected to the Diuretic-DH. Mean 6MWT was 129 m and mean KCCQ 40.5. Iron-DH functioned as a post-discharge checkpoint, ensuring therapeutic optimization, early identification of relapse, and continuity between inpatient care, telemonitoring, and community management.

Conclusion

The Iron-DH model, integrated with telemonitoring and diuretic-day-hospital pathways, represents a reproducible, internationally transferable framework for proactive HF management. More than a site for IV supplementation, Iron-DH provides an opportunity to reassess clinical stability, adjust therapy, and intercept early decompensations. This multidisciplinary, patient-centered model exemplifies how organizational innovation can bridge evidence and practice, improving care quality and autonomy for frail older adults with HF.For image description, please refer to the figure legend and surrounding text.