Treating anemia in heart failure patients: a review of erythropoiesis-stimulating agents.
BACKGROUND
Prevalence of chronic heart failure (CHF) is increasing, and despite improvements in the past decade the prognosis in terms of mortality and health-related quality of life remains poor. Anemia is often found concomitantly in CHF patients.


METHODS
Erythropoiesis-stimulating agents (ESAs) are a new treatment option for these anemic CHF patients, promising to decrease mortality and hospitalizations, and increase health-related quality of life.


RESULTS
CHF epidemiology is briefly discussed. Currently available clinical efficacy and safety data are critically appraised. Health care utilization by CHF patients, particularly hospitalizations, are reviewed in order predict cost-effectiveness of ESAs.


CONCLUSIONS
The efficacy for the most pertinent endpoints has not been proven by a pivotal trial or a meta-analysis free of bias, and there might be increased cardiovascular events and cancer incidence rates above a currently unknown target value or with multiple doses. However, subgroups should be identified in which ESAs might prove to be more efficacious and as safe as usual care and either cost-saving or cost-effective. Nevertheless, depending on the subgroup, the budget effect for payors might be dramatic due to the large number of CHF patients.
Geisler
Benjamin P
BP
Massachusetts General Hospital, Institute for Technology Assessment, Harvard Medical School, Boston, MA, USA. ben.geisler@gmail.com
D000740:Anemia / Q000097:blood / Q000150:complications / Q000188:drug therapy* / Q000191:economics / Q000401:mortality; D002908:Chronic Disease; D003362:Cost-Benefit Analysis; D003695:Delivery of Health Care / Q000706:statistics & numerical data; D016527:Drug Costs; D004920:Erythropoiesis / Q000187:drug effects*; D019317:Evidence-Based Medicine; D006333:Heart Failure / Q000097:blood / Q000150:complications* / Q000191:economics / Q000401:mortality; D006397:Hematinics / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D006760:Hospitalization; D006801:Humans; D016896:Treatment Outcome
D006397:Hematinics