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Reduction of cardiac iron overload by optimising iron chelation therapy in transfusion dependent thalassaemia using cardiac T2* MRI: a quality improvement project from Pakistan
  1. Shabneez Hussain1,
  2. Zahra Hoodbhoy2,
  3. Fatima Ali2,
  4. Erum Hasan3,
  5. Najveen Alvi2,
  6. Aijaz Hussain1,
  7. Khajista Ishrat1,
  8. Zia Ur Rahman1,
  9. Azizuddin Qamruddin1,
  10. Azra Parvin1,
  11. Babar S Hasan2
  1. 1 Fatimid Foundation, Karachi, Sindh, Pakistan
  2. 2 Department of Pediatrics and Child Health, The Aga Khan University and Hospital, Karachi, Sindh, Pakistan
  3. 3 Kashif Iqbal Thalassaemia Care Centre, Karachi, Sindh, Pakistan
  1. Correspondence to Dr Shabneez Hussain, Fatimid Foundation, Karachi, Sindh, Pakistan; shabneez.haem{at}


Objectives Cardiac T2* MRI (T2*CMR), for accurate estimation of myocardial siderosis, was introduced as part of a QI collaborative to optimise chelation therapy in order to improve cardiac morbidity in transfusion dependent thalassaemia (TDT) patients. We report the impact of this QI initiative from two thalassaemia centres from this collaborative.

Design and setting A key driver based quality initiative was implemented to improve chelation in TDT patients registered at these two centres in Karachi, Pakistan. Protocol optimisation and compliance to treatment through training, communication and feedback were used as the drivers for QI intervention. Preintervention variables (demographics, chelation history, T2*CMR, echocardiography and holters) were collected from January 2015 to December 2016) and compared with variables in the post implementation phase (January to December 2019). A standardised adverse event severity for chelators and its management was devised for safe drug therapy as well as ensuring compliance to the regimen. Preintervention and postintervention variables were compared using non-parametric test. P value<0.05 was statistically significant.

Results 100 patients with TDT, median age 17 (9–34) years, were included. An increase or stabilisation of T2*CMR was documented in 82% patients in the postintervention phase especially in patients with severe myocardial iron overload (5.5 vs 5.3 ms, p <0.01). Significantly fewer patients had abnormal echocardiographic findings (3.5% vs 26%, p <0.05) in the postintervention versus preintervention period.

Conclusion This QI initiative improved the chelation therapy leading to improved cardiac status in TDT patients at the participating centres.

  • cardiovascular diseases
  • health services research
  • outcome and process assessment
  • health care
  • patient reported outcome measures
  • quality indicators
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  • Contributors SH and BSH were involved in the overall concept and design of the study. SH, ZH, FA and NA were involved in data analysis and interpretation. EH, AH, KI, ZUR, AQ and AP were included in data collection. BSH performed the final review 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 This study was approved by the Fatimid Foundation Ethical Review Committee.

  • 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.

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