By Meaghan Lee Callaghan
A new electronic health record (EHR) screening tool that identifies iron deficiency in hospitalized patients with heart failure could greatly expand clinical pharmacy services while reducing readmissions and improving patient quality of life, according to a new report.

The tool—which could be easily adapted to various EHR systems—was able to identify iron deficiency in almost 25% of a New York City hospital’s acute decompensated heart failure patient census over six months last year, according to an abstract presented at the ASHP 2021 Midyear Clinical Meeting and Exhibition, held virtually.

Previously, the pharmacy consult service at the hospital intervened on about 20% of heart failure admissions, but never for iron deficiency, said study author Bryan C. Taylor, PharmD, a clinical pharmacist and the vice president of client relations at Creative Educational Concepts, in Lexington, Ky., which created the tool. 

“A lot of health systems don’t have an evidence-based algorithm that allows them to identify these patients with iron deficiency because it’s just not something that they commonly look for in patients with heart failure,” Dr. Taylor told Pharmacy Practice News. “There are so many other things to think about in patients with acute decompensated heart failure that clinicians historically have not thought about iron deficiency as an imminent clinical consideration.”

Identifying these patients before they’re discharged from the hospital will not only benefit the patients long term, but will also help to decrease healthcare costs, said Dr. Taylor, who pointed to a recent AFFIRM-AHF trial on IV ferric carboxymaltose ( Identifier: NCT02937454; Lancet 2020;396[10266]:1895-1904; Eur Heart J 2021;42[31]:3011-3020).

“That study essentially showed that using IV iron, as iron repletion therapy for heart failure patients before they leave the hospital, actually reduced the risk for heart failure readmissions,” Dr. Taylor said. “That not only improves morbidity and mortality, which is the most important thing, but it also reduces readmission rates and decreases healthcare utilization, thus allowing for more efficient resource allocation and reduced costs within health systems.

“This could be a real game changer for patients and for health systems alike.”

Using criteria from the AFFIRM-AHF trial, the EHR tool flagged patients with an ejection fraction of no more than 50%, hemoglobin less than or equal to 13 g/dL, ferritin levels no more than 300 mg/dL and transferrin saturation (TSAT) less than or equal to 20%. Evaluating patients from Jan. 1, 2021, to June 1, 2021, Dr. Taylor and fellow researcher Katherine E. DiPalo, PharmD, were also able to collect data on patient length of stay, inpatient consults including pharmacy consults, discharge disposition and scheduled follow-up. 

“As ID frequently is overlooked in hospitalized patients with heart failure, an expanded and novel pharmacist role can include recognizing appropriate patients and providing drug therapy recommendations for iron repletion prior to discharge,” the abstract stated.

Although actual patient outcomes data still need to be evaluated, the researchers said the screening process was a robust success. Of the 1,050 patients admitted for acute decompensated heart failure in the study period, 259 (24.6%) screened positive for iron deficiency. Although that is far fewer than the previous prevalence estimates, Dr. Taylor expects that number to increase, aided in part by the new EHR tool.

“A lot of the international pooled analyses that have been done in the past several years, as far back as 10 years ago, have established an aggregated estimated prevalence [or] approximate prevalence of about 50% for iron deficiency in heart failure, especially in heart failure with reduced ejection fraction,” Dr. Taylor said. This discrepancy is most likely due to a smaller sample size, he explained. “Our sample size isn’t big enough to adequately reflect the real-world population, but as we do additional work, we expect that prevalence figure to actually go up, not down.”