RT Journal Article
SR Electronic
T1 Reduction of cardiac iron overload by optimising iron chelation therapy in transfusion dependent thalassaemia using cardiac T2* MRI: a quality improvement project from Pakistan
JF Archives of Disease in Childhood
JO Arch Dis Child
FD BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health
SP 1041
OP 1048
DO 10.1136/archdischild-2020-319203
VO 105
IS 11
A1 Hussain, Shabneez
A1 Hoodbhoy, Zahra
A1 Ali, Fatima
A1 Hasan, Erum
A1 Alvi, Najveen
A1 Hussain, Aijaz
A1 Ishrat, Khajista
A1 Ur Rahman, Zia
A1 Qamruddin, Azizuddin
A1 Parvin, Azra
A1 Hasan, Babar S
YR 2020
UL http://adc.bmj.com/content/105/11/1041.abstract
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.