Background The prevalence of iron deficiency in heart failure (HF) is high (Okonko, Mandal, Missouris et al. J. Am. Coll. Cardiol. 2011;58:1241–1251) and found in patients with/without anaemia. It reduces quality of life, functional status and is a risk factor for hospital admissions (Nunez-Gil, Peraira-Moral. ESC Council for Cardiol Pract. 2012; 10(16):1–4). Intravenous iron is well-tolerated and effective. It improves breathlessness, fatigue and quality of life (Anker, Comin Colet, Filippatos, et al. N. Engl. J. Med. 2009;361:2436–2448; Ponikowski, Kirwan, Anker, et al. Lancet. 2020; 396:1895–1904).
Aim To set up a service to give palliative IV iron to HF patients, to deliver this care closer to home and support the NHS.
Methods Patients were discussed at HF MDT to assess suitability for referral, initially during the pandemic when patients had difficulty accessing this treatment in hospital. A policy and Standard Operating Procedure were written to ensure safety of patients receiving treatment. The Lead Nurse for the IV Day Care Service screened referrals, carried out holistic pre-assessments, was responsible for running the service, provided follow up and ensured other hospice services were offered.
Results From March 2022 to April 2023, 42 patients were referred. 20 did not meet the referral criteria. 23 iron infusions were administered with no adverse reactions. 17 patients received treatment. Of these, 8 required a second dose although two patients were unable to receive this as they became acutely unwell. Three patients who completed treatment chose to access other hospice services. Three patients were referred to the inpatient unit due to pre-assessment highlighting overwhelming symptoms. This avoided admissions to hospital. One patient received IV iron as an inpatient.
Conclusion Administration of intravenous iron in a hospice day unit is safe and will improve symptom control as well as reducing hospital admissions. It introduces the concept of hospice care to HF patients in a non-threatening way, demystifying what we do and reframing the organisation as one that can improve quality of life, rather than being focused on death.
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