Why the study?
Iron deficiency is a common comorbidity in HFrEF patients but remains under-recognized and undertreated despite guideline recommendations for intravenous iron therapy.
Does a multiphase quality improvement initiative increase iron deficiency screening and guideline-directed intravenous iron therapy in hospitalized patients with HFrEF?
Does a multiphase quality improvement initiative increase iron deficiency screening and guideline-directed intravenous iron therapy in hospitalized patients with HFrEF?
A multiphase quality improvement initiative successfully increased iron deficiency screening in hospitalized HFrEF patients but highlighted a persistent gap in administering guideline-directed intravenous iron therapy.
Screening rose >5-fold yet only 28% of iron-deficient HFrEF patients received IV iron; extends evidence that identification alone leaves treatment gaps unaddressed.
BACKGROUND: Iron deficiency is a common comorbidity among patients with heart failure with reduced ejection fraction (HFrEF), and it remains under-recognized and undertreated despite contemporary guideline recommendations for intravenous iron therapy. PROJECT RATIONALE: We sought to increase iron deficiency screening among hospitalized patients with HFrEF from a baseline of approximately 12% to >50% while identifying barriers to implementation of guideline-directed intravenous iron therapy. PROJECT SUMMARY: A multiphase Plan-Do-Study-Act quality improvement initiative integrated an iron panel into the heart failure admission order set, provided targeted provider education, and subsequently developed a standardized intravenous iron replacement protocol for integration into the electronic health record. Among 441 hospitalized patients with HFrEF, screening increased to 64.6% (285/441). Iron deficiency was identified in 243 of 285 screened patients (85.3%), yet only 67 (27.6%) received intravenous iron therapy. TAKE-HOME MESSAGES: Improving screening alone is insufficient to optimize iron deficiency care in hospitalized patients with HFrEF. Closing the gap between diagnosis and treatment will require workflow-integrated strategies to facilitate implementation of guideline-directed intravenous iron therapy.
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Easow et al. (2026) studied Heart failure with reduced ejection fraction (HFrEF) (n=441). Plan-Do-Study-Act quality improvement initiative vs. Baseline was evaluated on Iron deficiency screening rate. A quality improvement initiative integrating an iron panel into admission orders increased screening among hospitalized HFrEF patients from ~12% to 64.6%.
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