Screening and treatment of iron deficiency among heart failure patients with impaired ejection fraction: The impact of a pharmacist-led protocol

IF 1.3 Q4 PHARMACOLOGY & PHARMACY

Journal of the American College of Clinical Pharmacy : JACCP Pub Date : 2025-02-03 DOI:10.1002/jac5.2081

Jamila Alaryani BSPharm, Yosef Manla M.D., Emna Abidi Ph.D., Obada Kholoki M.D., Mohamed Hisham Pharm.D., Firas Al Badarin M.D., M.Sc, Feras Bader M.D., M.S., Bassam Atallah Pharm.D.

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Abstract

Background

Despite guideline-recommended routine screening and iron deficiency (ID) treatment among heart failure (HF) patients, these practices are often underutilized. Currently, limited data are available on the outcomes of pharmacists' programs to enhance ID screening and management. Accordingly, we sought to describe the frequency and yield of screening for ID and intravenous (IV) iron replacement rates among our cohort of HF patients and examined the impact of implementing a pharmacist-led protocol (PLP) aimed at enhancing these rates.

Methods

We conducted a retrospective study involving HF patients with left ventricular ejection fraction (LVEF) <45% at a quaternary care hospital in the Middle East/Gulf region. The PLP was introduced in August 2022. Data on demographics, comorbidities, echocardiographic parameters, laboratory findings (including ID screening and its findings), and rates of treatment with IV iron replacement were analyzed and compared between the pre-implementation group (n = 432, October 2015–February 2020) and the post-implementation group (n = 154, August 2022–January 2023).

Results

Before the PLP, 63.2% (n = 273) of eligible patients underwent ID screening, with 80.6% (n = 220) found to have ID. Following the implementation of the PLP, screening rates significantly increased to 86.4% (n = 133) (p = 0.03), with 53.4% (n = 71) diagnosed with ID. The rate of IV iron replacement in ID patients improved from 30.4% (n = 67) in the pre-PLP group to 73% (n = 52) in the post-PLP group (p < 0.001). Multivariable logistic regression identified baseline glomerular filtration rate (GFR) and hemoglobin levels as significant predictors of IV iron replacement in the pre-PLP cohort.

Conclusions

Implementing a pharmacist-led protocol was significantly associated with enhancing the screening and treatment of ID in patients with HF and LVEF <45%. This study demonstrates the crucial role of pharmacists in optimizing guideline-directed therapies, which can be replicated in various healthcare settings.

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