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Audit of the prevalence and investigation of iron deficiency anaemia in patients with heart failure in hospital practice
  1. Steny Simon1,
  2. Adam Ioannou2,
  3. Stuart Deoraj1,
  4. Sofia Metaxa1,
  5. Amit K J Mandal1,
  6. Constantinos G Missouris1,3
  1. 1 Department of Cardiology, Wexham Park Hospital, Frimley Health NHS Foundation Trust, Slough, Berkshire, United Kingdom
  2. 2 Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom
  3. 3 Department of Cardiology, University of Cyprus Medical School, Nicosia, Cyprus
  1. Correspondence to Professor Constantinos G Missouris, Department of Cardiology, Wrexham Park Hospital, Frimley Health NHS Foundation Trust, Slough, Berkshire, UK; dinos.missouris{at}


Purpose of the study Iron deficiency anaemia (IDA) is associated with increased morbidity and mortality in heart failure patients. The aim of our audit was to evaluate the current practice in diagnosis and assessment of IDA in patients admitted with heart failure.

Study design We conducted a retrospective audit of patients admitted to our hospital between January 2017 and June 2017 with a diagnosis of heart failure, and obtained data regarding each patient’s demographics and anaemic status. We also conducted a qualitative survey to assess healthcare professionals’ ability to diagnose IDA, and their knowledge of iron replacement in heart failure patients.

Results Our audit identified 218 heart failure patients, nearly two-thirds (n=138, 63.3%) of which were anaemic. Of the 138 anaemic patients, only 40 had a full haematinic screen compared with 98 who had incomplete investigations (29% vs 71%, p=0.007). Iron studies were the most commonly performed haematinic investigation (n=87, 63%), and over half of these patients were iron deficient (n=49, 56.3%). Only 12 (24.5%) iron deficient patients were prescribed oral iron therapy, while 37 (75.5%) were left without iron replacement (X2=12.8, p=0.0003). Our survey demonstrated a lack of awareness among healthcare professionals with only 19.7% of participants being able to correctly define anaemia and 9.1% being aware of guidelines regarding treatment of IDA.

Conclusion Many patients admitted to hospital with heart failure also have a concomitant diagnosis of anaemia. The aetiology of the underlying anaemia is often poorly investigated, and where IDA is identified it is poorly treated.

  • anaemia
  • Iron deficiency anaemia (IDA)
  • heart failure

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  • Contributors All six authors contributed to the manuscript. SS, AI, SD and CM designed the study. SS and SD collected the data. SD was responsible for the statistical analysis. AI, SM, AM and CM wrote and edited the manuscript. All authors were involved in the final approval of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The above audit was approved by our Trust Audit Department with reference CB258. As an audit using clinically collected, non-identifiable data, this work does not fall under the remit of the National Health Service Research Ethics Committees. The qualitative survey used to assess the knowledge of healthcare professionals was also approved by our Trust Audit Department with reference CB585, and as a survey that only involved clinical staff and did not involve any patients, or use of patient data it also did not fall under the remit of the National Health Service Research Ethics Committees.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.