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Survey on cardiologists’ views and management of heart failure and concomitant ID in China

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Dear Colleague,
The Chinese Geriatrics Society Precision Medicine for Comorbidity Committee is asking for your participation in a new survey. This survey aims to map cardiologists’ views and management of heart failure and concomitant iron deficiency in China. The survey will take less than 15 minutes and your participation is anonymous. You have the right to end your participation in this survey at any time.
If you have any comments or questions about the survey, feel free to contact us at: sln920722@163.com, lipz7014@163.com.
Thank you in advance for your contributions.

The Chinese Geriatrics Society Precision Medicine for Comorbidity Committee

Note: we comply with the Declaration of Helsinki. Any personal data processed in connection with this survey will be treated confidentially and only used by the Chinese Geriatrics Society for this research. Survey results will be kept for a maximum of 48 months for analysis and quality control purposes. We take all reasonable care to prevent any unauthorized access to your personal data. We respect your privacy and your right to access, modify, or remove your personal data. At any time, you can ask to know what personal data is being held.

Have you read the above and do you agree to participate in this survey?

Yes

Part 1. General information

1. Your gender is:

A. male

B. female

2. Your age is: yrs.*

3. You are from ______ province, ______ city in China

You are from ______ Hospital (please specify the full name of your hospital)

4. Where do you practice?

A. University hospital

B. General hospital (If you are practicing at a university hospital, please choose A)

C. Private hospital or private practice

D. Specialized public cardiology center

5. What is your primary subspecialty in cardiology?

A. General cardiology

B. Heart failure

C. Interventional cardiology

D. Cardiac electrophysiology and pacing

E. Hypertension

F. Cardiomyopathy

G. Structural heart disease

H. Intensive care

I. Cardiovascular metabolism

J. Cardiovascular imaging

K. Others, specifically

6. How many years of experience do you have in cardiology?

A. ＜5 years

B. 5~10 years

C. 10~20 years

D. ＞20 years

7. Do you routinely follow up patients with HF in an outpatient clinic?

A. Yes

B. No

8. For a patient in NYHA Class III - how often will they be seen?

A. Every month

B. Every 2-3 months

C. Every 4-6 months

D. Only when patient asks

9. For a patient in NYHA Class I/II - how often will they be seen?

A. Every month

B. Every 2-3 months

C. Every 4-6 months

D. Only when patient asks

Part 2. Screening and diagnosis

10. Which of the following conditions are associated with iron deficiency?(Multi-options)【Choose at least 1 item】

A. Gynecological diseases (e.g., hysteromyoma, gynecologic malignancies.)

B. Heart failure

C. Renal dysfunction

D. Inflammatory bowel disease

E. Tumors

F. Perioperative period

Additional questions: How confident are you in the answer to the above question? (Select ranking from 1 [Not confident] to 5 [Very confident])

A. 1 - Not confident

B. 2 - Slightly confident

C. 3 - Somewhat confident

D. 4 - Confident

E. 5 - Very confident

11. What is the estimated prevalence of iron deficiency in patients with chronic and acute heart failure, respectively?

A. ＜10%, 30-40%

B. 10-30%, 50-60%

C. 30-50%, 60-70%

D. 50-60%, 70-80%

E. 60-80%, >80%

F. I don’t know

12. In which of the following conditions should heart failure patients be considered for screening for iron deficiency?

A. Only in patients presented with symptoms of iron deficiency, such as fatigue, weakness, or pallor.

B. Only in patients when hemoglobin is below normal certain limit

C. Part of routine care

D. Not necessary

13. Which phenotype of heart failure should be screened for iron deficiency?

A. Heart failure with LVEF ≤40%

B. Heart failure with LVEF 41-49%

C. Heart failure with LVEF <50%

D. Heart failure with LVEF ≥50%

E. Across the spectrum of LVEF

F. I don’t know

14. Which two of the following laboratory indices are recommended for screening iron deficiency in patients with heart failure? 【Please select 2 item】

A. Serum ferritin

B. Transferrin

C. Serum iron

D. Transferrin saturation (TSAT)

E. Total iron binding force (TIBC)

F. Unsaturated iron-binding capacity (UIBC)

G. Soluble transferrin receptor (sTfR)

H. Bone marrow aspiration for iron staining

Additional questions: How confident are you in the answer to the above question? (Select ranking from 1 [Not confident] to 5 [Very confident])

A. 1 - Not confident

B. 2 - Slightly confident

C. 3 - Somewhat confident

D. 4 - Confident

E. 5 - Very confident

15. Which definition of anemia do you agree with?

A. Hb＜100g/L (male), ＜90g/L (female)

B. Hb＜110g/L (male), ＜100g/L (female)

C. Hb＜120g/L (male), ＜110g/L (female)

D. Hb＜130g/L (male), ＜120g/L (female)

E. I don’t know

16. According to guideline criteria, how is iron deficiency in heart failure defined?

A. Serum ferritin ＜100 ng/mL and hemoglobin (Hb) ＜120 g/L

B. Transferrin saturation (TSAT) ＜20% and hemoglobin (Hb) ＜120 g/L

C. Transferrin saturation (TSAT) ＜20%

D. Serum ferritin 100-300 ng/mL and transferrin saturation (TSAT) ＜20%

E. Serum ferritin ＜100 ng/mL and transferrin saturation (TSAT) ＜20%

F. Serum ferritin ＜100 ng/mL, or serum ferritin 100-300ng/mL and transferrin saturation (TSAT) ＜20%

Additional questions: How confident are you in the answer to the above question? (Select ranking from 1 [Not confident] to 5 [Very confident])

A. 1 - Not confident

B. 2 - Slightly confident

C. 3 - Somewhat confident

D. 4 - Confident

E. 5 - Very confident

17. What is the actual percentage of heart failure patients screened for iron deficiency in your clinical practice?

A. ＜20%

B. 20-40%

C. 40-60%

D. 60-80%

E. ＞80%

18. Do you think that iron deficiency affects the prognosis of patients with heart failure (e.g., mortality or rehospitalization)?

A. Iron deficiency does not affect the prognosis of patients with heart failure

B. Iron deficiency does not affect the prognosis of patients with heart failure when anemia is absent

C. Iron deficiency affects the prognosis of patients with heart failure regardless of anemia

D. I don’t know

19. Do you think iron deficiency affects the quality of life in patients with heart failure?

A. Iron deficiency does not affect the quality of life in patients with heart failure

B. Iron deficiency does not affect the quality of life in patients with heart failure when anemia is absent

C. Iron deficiency affects the quality of life in patients with heart failure regardless of anemia

D. I don’t know

20. Do you think iron deficiency affects the exercise capacity of patients with heart failure?

A. Iron deficiency does not affect the exercise capacity of patients with heart failure

B. Iron deficiency does not affect the exercise capacity of patients with heart failure when anemia is absent

C. Iron deficiency affects the exercise capacity of patients with heart failure regardless of anemia

D. I don’t know

21. Which of the following iron-related laboratory indices are available in your hospital? (Multi-options)【Choose at least 1 item】

A. Serum ferritin

B. Transferrin

C. Serum iron

D. Transferrin saturation (TSAT)

E. Total iron binding capacity (TIBC)

F. Unsaturated iron binding capacity (UIBC)

G. Soluble transferrin receptor (sTfR)

H. Bone marrow aspiration for iron staining

22. Are these aforementioned available iron-related laboratory indices covered by medical reimbursement in your hospital?

A. Full reimbursement

B. Partial reimbursement

C. No reimbursement

Part 3. Treatment

23. Based on the existing evidence, which phenotype of heart failure patients is recommended for iron supplementation?

A. Heart failure with LVEF ≤40%

B. Heart failure with LVEF 41-49%

C. Heart failure with LVEF <50%

D. Heart failure with LVEF ≥50%

E. Across the spectrum of LVEF

F. I don’t know

24. Assuming that you want to prescribe iron repletion to a heart failure patient with iron deficiency, what is your preference?

A. Oral iron

B. Intravenous iron

C. Combination therapy

D. I don’t know

25. How large an iron deficit you have before tests suggest ID?

A. ＞2000mg

B. 1500 ~ 2000mg

C. 1000 ~ 1500mg

D. 500 ~ 1000mg

E. ＜500mg

26.How much oral iron do you suppose can be absorbed?

A. ＜10%

B. 10-30%

C. 30-50%

D. 50-70%

E. ＞70%

27. In which of the following conditions should intravenous iron be considered in heart failure patients?

A. Once the patient meets the criteria for iron deficiency

B. Only the patient cannot tolerate oral iron

C. Only the patient has gastrointestinal disorders affecting the absorption of oral iron

D. Only the patient meets the criteria for anemia

E. I don’t know

28. Which of the following statements are true about the establishment of clinical benefits of iron repletion in HF patients? (Multi-options)【Choose at least 1 item】

A. Reduced the risk of CV death with no apparent effect on HF hospitalization

B. Reduced the risk of HF hospitalization with no apparent effect on CV death

C. Significantly reduced the risk of both HF hospitalization and CV death

D. Improved the quality of life

E. Improved the exercise capacity

Additional questions: How confident are you in the answer to the above question? (Select ranking from 1 [Not confident] to 5 [Very confident])

A. 1 - Not confident

B. 2 - Slightly confident

C. 3 - Moderately confident

D. 4 - Mostly confident

E. 5 - Very confident

29. Based on the latest evidence, which type of intravenous iron is recommended for treating heart failure patients with iron deficiency? (Multi-options)【Choose at least 1 item】

A. Low molecular weight iron dextran

B. Iron gluconate

C. Iron sucrose

D. Iron sorbitol

E. Ferric carboxymaltose (FCM)

F. Ferric derisomaltose (FDI)

G. I don’t know

30. Which of the following oral iron preparations can be prescribed at your hospital? (Multi-options)【Choose at least 1 item】

A. None

B. Ferrous sulfate

C. Polysaccharide iron complex

D. Iron proteinsuccinylate oral solution

E. Ferrous fumarate

F. Ferrous succinate

G. Ferrous gluconate

H. Others, specifically

I. I don’t know

31. Which of the following intravenous iron preparations can be prescribed at your hospital? (Multi-options)【Choose at least 1 item】

A. None

B. Low molecular weight iron dextran

C. Iron gluconate

D. Iron sucrose

E. Iron sorbitol

F. Ferric carboxymaltose (FCM)

G. Ferric derisomaltose (FDI)

H. Others, specifically

I. I don’t know

32. Have you ever prescribed an infusion of intravenous iron in heart failure patients with iron deficiency?

A. Yes

B. No

33. Which of the following intravenous iron preparations have you ever prescribed? (Multi-options)【Choose at least 1 item】

A. Low molecular weight iron dextran

B. Iron gluconate

C. Iron sucrose

D. Iron sorbitol

E. Ferric carboxymaltose (FCM)

F. Ferric derisomaltose (FDI)

G. Others, specifically

34. What is your first consideration in terms of iron preparation choice when prescribing intravenous iron to patients with heart failure?

A. Single high-dose infusion (e.g., 1000mg one dose versus 200mg five doses)

B. Adverse effects

C. Patients’ financial burdens (e.g., not covered by medical reimbursement)

D. Clinical evidence or experience

E. Others, specifically

35. What prevents you from prescribing intravenous iron in heart failure patients? (Multi-options)【Multiple】

A. Not necessary to give iron supplementation

B. Oral iron supplementation should be the first choice

C. Concerns about side effects of intravenous iron

D. Lacks experience of using intravenous iron

E. Concerns about reimbursement

F. Intravenous iron preparations are not available at my hospital

G. No facilities for intravenous iron infusion

H. Others, specifically

36. Are you familiar with calculating methods of the required dose of iron in heart failure patients with iron deficiency?

A. Yes

B. No

37. Which of the following approaches are you familiar with to calculate the required iron dose? (Multi-options)

A. Simplified scale method

B. Ganzoni formula method

C. Fixed dose

D. Others, specifically

Additional questions: How confident are you in the answer to the above question? (Select ranking from 1 [Not confident] to 5 [Very confident])

A. 1 - Not confident

B. 2 - Slightly confident

C. 3 - Somewhat confident

D. 4 - Confident

E. 5 - Very confident

38. For HFrEF patients with iron deficiency, when should iron repletion be initiated relative to GDMTs that include the four major pillars: RAASi/ARNi, beta-blockers, SGLT2i, and MRA?

A. Initiated oral iron with GDMTs simultaneously

B. Initiated intravenous iron with GDMTs simultaneously

C. Initiated oral iron after GDMTs titrated to target doses or maximally tolerated doses

D. Initiated intravenous iron after GDMTs titrated to target doses or maximally tolerated doses

E. I don’t know

39. If prescribed together, whether the four major pillars (RAASi/ARNi, MRA, beta-blockers, SGLT2i) of treating HFrEF could interact with intravenous iron?

A. Yes, RAASI/ARN could interact with intravenous iron

B. Yes, MRA could interact with intravenous iron

C. Yes, beta-blockers could interact with intravenous iron

D. Yes, SGLT2i could interact with intravenous iron

E. No, they do not interact with each other

F. I don’t know

40. When should iron repletion be considered in hospitalized acute decompensated heart failure patients with iron deficiency?

A. Initiate as early as possible regardless of stabilization

B. Initiate as early as possible after stabilization

C. Initiate before discharge

D. Initiate after discharge

E. I don’t know

41. What is the major iron-specific side effect associated with intravenous iron preparations? (Multiple options)

A. Fishbane reaction symptoms (flushing, chest or back pain, and joint pain)

B. Nausea

C. Tachycardia

D. Hypophosphatemia

E. Wheezing caused by bronchospasm

F. I don’t know

42. In which of the following adverse events should you withdraw intravenous iron therapy for treating heart failure patients with iron deficiency?【Choose at least 1 item】

A. Fishbane reaction symptoms (flushing, chest or back pain, and joint pain)

B. Severe urticaria

C. Hypotension

D. Loss of consciousness

E. Cardiac/respiratory arrest

F. Wheezing caused by bronchospasm

G. Hypophosphatemia

H. I don’t know

Part 4. Follow-up

43. If you have prescribed an intravenous iron infusion for a heart failure patient, what is the interval for follow-up to check the effect and/or look for recurrent iron deficiency?

A. Yes, usually around after 3 months

B. Yes, usually around after 6-9 months

C. Yes, usually after 12 months

D. No necessary

E. Others, specifically

F. I don’t know

44. During the follow-up, what is the treatment target you prefer for iron repletion therapies in heart failure patients with iron deficiency?

A. Serum ferritin >300 ng/mL or TSAT >20%

B. Serum ferritin >400 ng/mL or TSAT >25%

C. Serum ferritin >500 mg/L or TSAT >30%

D. Serum ferritin >700 mg/L or TSAT >40%

E. Serum ferritin >800 mg/L or TSAT >50% or Hb >160g/L

F. Not sure

45. Assuming that you want to prescribe intravenous iron to a patient with iron deficiency, what is your preference?

A. In-hospital patients only

B. Ambulatory or daycare-unit patients only

C. Both in-hospital and ambulatory patients

D. Referral to different departments, e.g., Hematology

Part 5. Educational requirements

46. Would you like to receive education about iron deficiency and heart failure?

A. Yes

B. No

47. Which format would you prefer? (Multi-options)【Choose at least 1 item】

A. Continuing education courses

B. Online academic conferences on iron deficiency

C. In-person academic conferences on iron deficiency

D. Online platform courses or lecture series

E. WeChat public account or specialist website articles

F. Others, specifically

48. What specific aspect of iron deficiency and heart failure would you like to learn more about? (Multi-options)【Choose at least 1 item】

A. Pathophysiology of iron deficiency

B. Clinical manifestations of iron deficiency

C. Testing indexes and diagnostic criteria for iron deficiency

D. Treatments for iron deficiency and adverse reactions

E. Current guideline recommendations for iron deficiency in heart failure

F. Others, specifically

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