Evaluation of a Pharmacist-Led Intravenous Iron Therapy Transitions of Care Service in Heart Failure

Abstract

Background:

The guidelines recommend intravenous (IV) iron for patients with heart failure (HF) with a reduced or mildly reduced ejection fraction. IV iron is often administered during hospitalization. However, care transitions from inpatient to outpatient settings for IV iron are suboptimal, and only about one-third of patients receive follow-up iron study measurements to assess the need for IV iron at outpatient settings after inpatient IV iron. Limited data is available to improve the current practice of IV iron during care transitions.

Objective:

To evaluate the post-discharge performance of the pharmacist-led iron deficiency transitions of care initiative for patients with HF who received IV iron during hospitalization.

Methods:

This retrospective cohort study included patients with HF who received ferric gluconate during hospitalization and was managed by the pharmacist-led iron deficiency transitions of care service (post-implementation group), compared to patients managed under the usual care during hospitalization (pre-implementation group). The primary outcome was the attainment of follow-up iron study and hemoglobin measurements within 6 months after the ferric gluconate induction course. The secondary outcomes included the provision of IV iron maintenance doses at outpatient settings for patients who had iron deficiency after the induction course.

Results:

A total of 43 patients in the post-implementation group and 92 patients in the pre-implementation group were included in the analysis. The primary outcome was significantly higher in the post-implementation group (83.7 vs. 28.3%, p<0.001). For patients who had follow-up labs and were indicated for IV iron maintenance doses, a significantly higher number of patients in the post-implementation group received IV iron maintenance doses compared to the pre-implementation group (80 vs. 14.3%, p<0.001).

Conclusion and Relevance:

The pharmacists-led iron deficiency transitions of care service can improve attainment of follow-up labs and provision of IV iron maintenance doses during care transitions from inpatient to outpatient settings.