Erythropoiesis stimulating agents in heart failure patients with anemia: a meta-analysis.
BACKGROUND
Anemia is prevalent in patients with heart failure and an independent prognostic sign of poor outcome. The current report is a meta-analysis of published clinical trials assessing the use of erythropoeisis stimulating agents (ESA) in heart failure (HF) patients with anemia.


METHODS
Literature and Medline search was performed to identify studies with control groups (case-control, cohort or randomized controlled trials) that examined the effect of ESA therapy in patients with HF and anemia.


RESULTS
Seven prospective controlled trials met inclusion criteria (n = 663 subjects). The ESA studied was darbepoetin in 4 trials and erythropoietin in 3 trials. Mean follow up period ranged from 12 to 27 weeks. Compared to placebo ESA therapy was associated with improvement in six cardiovascular parameters assessed by at least three of the analyzed trials, including increase in hemoglobin levels 2.35(95% confidence interval [Cl], 1.76-2.93, P < 0.00001), increase in exercise duration 0.91(95% Cl, 0.08-1.73, P = 0.03), improvement in New York Heart Association functional class -1.46(95% Cl, -2.32 to -0.60, P = 0.0009), improvement in 6-minute walk test 1.42(95% Cl, 0.31-2.54, P = 0.01), decrease in B-type natriuretic peptide -0.54(95% Cl, -1.03 to -0.06, P = 0.03), and improvement in peak oxygen consumption 0.93(95% Cl, 0.52-1.34, P < 0.00001).


CONCLUSIONS
In patients with heart failure and anemia, erythropoiesis stimulating agent therapy appears to have a positive effect on several important cardiovascular parameters, compared to control therapy. Large prospective randomized controlled trials are warranted to comprehensively evaluate the potential effects of erythropoiesis stimulating agents on clinical outcomes in heart failure patients with anemia.
Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, 8700 Beverly Blvd, #5534, Los Angeles, CA 90048, USA. tehranif@cshs.org
Faramarz
F
Tehrani
Pavittarpaul
P
Dhesi
Daniel
D
Daneshvar
Anita
A
Phan
Asim
A
Rafique
Robert J
RJ
Siegel
Bojan
B
Cercek
D000740:Anemia / Q000188:drug therapy* / Q000209:etiology*; D002986:Clinical Trials as Topic; D005080:Exercise Test / Q000187:drug effects; D006333:Heart Failure / Q000150:complications* / Q000188:drug therapy; D006397:Hematinics / Q000627:therapeutic use*; D006454:Hemoglobins / Q000187:drug effects; D006801:Humans; D020097:Natriuretic Peptide, Brain / Q000187:drug effects; D010101:Oxygen Consumption / Q000187:drug effects
D006397:Hematinics; D006454:Hemoglobins; D020097:Natriuretic Peptide, Brain