2025 Southeastern Residency Conference

Title: Evaluating Iron Sucrose Discordance Among Patients Within  
Cone Health Outpatient Infusion Centers   


Authors: Jessica Robles, Yatin Patel


Objective: Evaluate the impact of transitioning iron sucrose administration to IV push on iron sucrose discordance and infusion reactions


Self-Assessment Question: True or False: The incidence of infusion reactions with iron sucrose 200 mg is similar between administration via IV push vs IVPB infusion.


Background: Discordance is defined as an inappropriate dose or timing of administration of intravenous (IV) iron based on institutional policies. Social drivers of health, which are nonmedical factors impacting health outcomes, likely play a role in IV iron discordance. Social drivers of health can be quantified through a social vulnerability index (SVI), which is a novel composite measure encompassing variables that correspond to key social drivers of health; however, SVIs have not been studied in the evaluation of iron discordance. The dosing schedule of IV iron products also likely contributes to discordance. Older-generation IV iron products require more frequent dosing and have a higher incidence of discordance, but these products continue to have high utilization due to payor coverage and lower cost per dose. Iron sucrose, an older-generation IV iron product, is Cone Health’s preferred IV iron product, therefore it is essential to continually optimize its use by the health-system. In response to the nationwide fluid shortage, Cone Health outpatient infusion centers transitioned the administration of iron sucrose 200 mg doses from an IV piggyback (IVPB) infusion to an IV push. The purpose of this study was to evaluate the impact of this transition on iron sucrose discordance.


Methods: This was an IRB-reviewed and exempt, multi-center, pre-post study which evaluated iron sucrose discordance over three-month periods in the pre- and post-intervention groups. Adults who received their prescribed course of iron sucrose within the study period at one of the ten Cone Health outpatient infusion centers were included. Patients who did not have a Federal Information Processing Standards (FIPS) code available were excluded. The primary outcome was the incidence of iron sucrose discordance. A treatment course was deemed discordant if the patient did not receive at least one gram of iron sucrose within a 14-day period. Secondary outcomes included reason for iron sucrose discordance, incidence of iron sucrose infusion reactions, and Centers for Disease Control and Prevention and Agency for Toxic Substances and Disease Registry (CDC/ATSDR) SVI rankings. Primary and secondary outcomes were analyzed using descriptive statistics and a multiple regression model.


Results: There were 613 treatment courses included in the pre-intervention group, while 543 treatment courses were included in the post-intervention group. Among both groups, patient demographics were not statistically different, and most treatment courses were administered at a Cone Health cancer center (82.5% in the pre-intervention group vs 79.6% in the post-intervention group). After the transition of 200 mg doses to IV push, the usage of 200 mg doses increased from 71.2% to 82.7% (p < 0.001), and the incidence of discordance was statistically unchanged (88.9% vs 87.7%; p < 0.26). The incidence of discordance due to insufficient dose decreased in the post-intervention group (68.4% vs 57.3%, p=0.001); however, the incidence of discordance due to prolonged duration increased in the post-intervention group (15.4% vs 19.5%, p=0.001). The incidence of infusion reactions was not statistically different between groups (0.3% vs 0.06%, p=0.15). There was not a clear difference in SVI rankings between concordant and discordant treatment courses. 


Conclusion: The transition of 200 mg iron sucrose doses to administration via IV push did not impact the incidence of discordance or infusion reactions, suggesting utility in the continued use of 200 mg push doses even after the resolution of the fluid shortage. The transition appeared to result in more patients receiving at least one gram of iron sucrose but increased the duration of the treatment course. There was no clear relationship found between SVI rankings and iron sucrose discordance.