PT - JOURNAL ARTICLE AU - Shabneez Hussain AU - Zahra Hoodbhoy AU - Fatima Ali AU - Erum Hasan AU - Najveen Alvi AU - Aijaz Hussain AU - Khajista Ishrat AU - Zia Ur Rahman AU - Azizuddin Qamruddin AU - Azra Parvin AU - Babar S Hasan TI - Reduction of cardiac iron overload by optimising iron chelation therapy in transfusion dependent thalassaemia using cardiac T2* MRI: a quality improvement project from Pakistan AID - 10.1136/archdischild-2020-319203 DP - 2020 Nov 01 TA - Archives of Disease in Childhood PG - 1041--1048 VI - 105 IP - 11 4099 - http://adc.bmj.com/content/105/11/1041.short 4100 - http://adc.bmj.com/content/105/11/1041.full SO - Arch Dis Child2020 Nov 01; 105 AB - 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.