Investigation reveals £21 million NHS bill for avoidable deficiencies in heart failure


Inadequate management of iron deficiency (ID) and iron deficiency anaemia (IDA) in heart failure (HF) costs the NHS an extra £21.5 million per year due to lengthier and costlier hospital stays, real-world NHS data reveals


Credit: Vifor Pharma

Today, the first investigation of its kind, published in Open Heart, has identified the hidden costs of heart failure (HF) due to under-managed but treatable iron deficiency (ID) and iron deficiency anaemia (IDA). Leading UK clinicians assessed the one-year data of around 80,000 people with HF as part of the analysis.1 Nearly one million people in the UK live with HF, of whom around 50% may also suffer from ID.3,4 However, the investigation revealed that potentially a third of people with HF are not being screened for ID/IDA, with potentially debilitating effects on their quality of life.1,4

ID is simple to identify and treat, but widely ignored. It can lead to avoidable cases of patients arriving as emergencies at A&E departments throughout the country and adds to existing hospital bed pressures.1 This analysis has found that HF patients found to have ID/IDA are more likely to be re-admitted to hospital within 30 days than those without ID, 95% of whom present as emergency admissions.1 With an NHS deficit of £960 million reported for 2017/2018, hospital bed occupancy hitting an eight-year high in 2018, and a near 7% rise in emergency admissions to hospitals reported for 2018/19, correct management of these patients presents an opportunity for cost-savings for an over-stretched healthcare system.5-7

Dr Rani Khatib, Consultant Pharmacist in Cardiology and Cardiovascular Research, Leeds Teaching Hospitals and co-author of the analysis published in Open Heart added, “Some evidence suggests that iron studies are conducted in less than 20% of heart failure patients admitted to NHS Trusts, which is not enough when you consider that 50% of these patients are likely to be iron deficient. The published data estimate an additional £21.5 million a year is being spent on managing co-morbid patients with heart failure and iron deficiency or iron deficiency anaemia, and this is based on the small proportion of those who were found from testing, so the true cost is likely to be much higher. There is a clear need to raise awareness about the growing evidence in this area and translate into practice accordingly.”

IDA is one of 19 ambulatory care sensitive conditions (ACSCs), where effective community care and case management can help prevent the need for hospital admissions.8 It is estimated that emergency admissions for ACSCs could be reduced by up to 18%, and this study highlights that consistent management of ID/IDA, treatable co-morbidities in HF, could help relieve some of the current burden on the NHS and improve the quality of life of patients.1,8

Across the NHS, there is a clear disparity in the care that patients with HF receive.2 In patients who were screened and treated for ID, data show that the amount of time they spent in hospital varied widely, with a difference of up to 18 bed days.2 Patients across the lowest and highest tier Clinical Commissioning Groups (CCGs) across England spent eight and 26 days in hospital respectively, with each day costing the NHS around £400 per patient.2 This disparity suggests that international guidance is not being consistently followed. European, Scottish and American guidance highlight the importance of managing ID/IDA in HF in order to improve patients’ quality of life and exercise capacity and reducing hospitalisations, recommending that clinicians consider available intravenous iron therapy in appropriate patients.9-11

“Current clinical opinion widely acknowledges that the treatment of iron deficiency in heart failure not only improves patients’ functional capacity and symptoms, but most importantly, their quality of life. Treatment can also reduce time-consuming hospital visits for patients and costly readmissions for the wider healthcare economy” says Dr Simon Williams, Consultant Cardiologist, Wythenshawe Hospital, Manchester and fellow co-author of the analysis published in Open Heart. “Our colleagues in Scotland, America and Europe have guidance that provides them with recommendations for treatment of these co-morbid patients, it is disappointing that we are lagging behind and do not have such standardised recommendations to refer to here in England and Wales.”


For more information contact:

Cello Health Communications

Christian Petrovic, Project Director

Tel: 07741 894 518

Email: [email protected]

Vifor Pharma UK

Janine Hogan, Head of Communications

Tel: 07738 438 493

Email: [email protected]

Notes to editors

Report authors:

1. Dr James M Beattie, King’s College Hospital, London, visiting Senior Lecturer, Cicely Saunders Institute

2. Dr Rani Khatib, Consultant Cardiology Pharmacist, Leeds Teaching Hospitals NHS Trust and University of Leeds

3. Professor Ceri J Phillips, Professor of Health Economics, College of Human and Health Sciences, Swansea University

4. Dr Simon G Williams, Consultant Cardiologist, University Hospital of South Manchester NHS Foundation Trust, Wythenshawe Hospital


HES data were acquired under a commercial re-use licence via Harvey Walsh Ltd., funded by Vifor Pharma UK Ltd. Neither company had any role in the study design, analysis, or interpretation of the data. Editorial assistance on an initial draft of this manuscript based on an agreed outline approved by the authors, was provided by IS Healthcare Dynamics Ltd. (trading as Cello Health Communications), also funded by Vifor Pharma UK Ltd. However, no commercial entity had any role in the development and composition of this paper, or the decision to submit for publication.

About iron deficiency in heart failure

Iron is an essential component for all living organisms, playing a vital role in the transport of oxygen around the body and the formation of DNA. A lack of iron stores in the body can lead to serious clinical consequences, with iron deficiency compounding conditions like heart failure by altering the heart muscle. Iron deficiency in heart failure leads to poorer cardiovascular outcomes and increased hospitalisations while having a considerable impact on patients’ quality of life, despite simple screening and readily available treatments.

About Vifor Pharma UK

Vifor Pharma UK, affiliated to Vifor Pharma Group, which is a world leader in the discovery, development, manufacturing and marketing of pharmaceutical products for the treatment of iron deficiency, is based in Bagshot, Surrey. Established in the UK in 2010, Vifor Pharma UK has grown in size and commands a market leading position in the intravenous iron therapy market. With this focus on the area of iron replacement therapy for the treatment of iron deficiency with or without anaemia, Vifor Pharma UK develop and manufacture intravenous iron replacement drugs. Vifor Pharma UK invests resources and funding for the education of healthcare professionals and for appropriate public awareness of iron deficiency and iron deficiency anaemia.


1. Beattie J, et al. Iron deficiency in 78 805 people admitted with heart failure across England: a retrospective cohort study openheart. 2020;7:e001153

2. Data on file: Hospital Episode Statistic Data 2015/2016 (accessed under a commercial re-use licence via Harvey Walsh Ltd.)

3. National Institute for Health and Care Excellence. Chronic heart failure in adults: diagnosis and management. Available at: Accessed September 2019.

4. McDonagh T and Macdougall I C. Iron therapy for the treatment of iron deficiency in chronic heart failure: intravenous or oral? Eur J Heart Fail. 2015;17(3):248-262.

5. The King’s Fund. 2019. Trusts in deficit. Available at: Accessed September 2019.

6. The King’s Fund. 2018. How is the NHS performing? June 2018 quarterly monitoring report. Available at: Accessed September 2019.

7. NHS England. 2019. Annual Report and Accounts 2018/19. Available at: Accessed September 2019.

8. The King’s Fund. 2012. Emergency hospital admissions for ambulatory care-sensitive conditions: identifying the potential for reductions. Available at: Accessed September 2019.

9. Ponikowski P, et al. European Society of Cardiology guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2016;37(27):2129-2200. doi: 10.1093/eurheartj/ehw128.

10. Scottish Intercollegiate Guidelines Network. 2016. Management of chronic heart failure. A national clinical guideline. Available at: Accessed September 2019.

11. Yancy CW, et al. 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. J Am Coll Cardiol. 2017;70(6):776-803.

12. Abbaspour N, Hurrell R and Kelishadi R. Review on iron and its importance for human health. J Res Med Sci. 2014;19(2):164-174.

13. Jankowska E A, et al. Iron deficiency and heart failure: diagnostic dilemmas and therapeutic perspectives. Eur Heart J. 2013;34:816-829. doi: 10.1093/eurheartj/ehs224.

14. Ponikowski P, et al. Beneficial effects of long-term intravenous iron therapy with ferric carboxymaltose in patients with symptomatic heart failure and iron deficiency. Eur Heart J. 2014;36(11):657-668. doi:10.1093/eurheartj/ehu385.

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