title: Clinical outcomes of erythropoietin use in heart failure patients with anemia of chronic kidney disease.
abstract: BACKGROUND
  Anemia and chronic kidney disease are common disorders in heart failure (HF) patients and are associated with increased morbidity and mortality. This study assessed clinical outcomes associated with erythropoietin (EPO) treatment in this cardiorenal anemia syndrome (CRAS) population.
  
  
  RESULTS
  This was a retrospective cohort study of Veterans Affairs patients with CRAS from January 2003 to December 2006. The primary outcome was a composite of death, acute coronary syndrome (ACS), HF, and stroke. Multiple Cox regression modeling was used to evaluate the outcome in patients prescribed (n = 213) and not prescribed EPO (n = 1845). Adjusted incidence of mortality was statistically significantly higher in EPO than in non-EPO users (33.8% vs 19.7%; hazard ratio 1.40, 95% confidence interval 1.06-1.85; P = .02). The unadjusted composite of cardiovascular events/death was higher in the EPO group, but not statistically significant when adjusted for confounders (P = .12). Crude ACS events were documented in 18.8% and 10.8% patients (P = .001), and stroke events occurred in 22.5% and 18.3% patients (P = .14) in EPO and non-EPO groups, respectively.
  
  
  CONCLUSIONS
  We found that in CRAS patients, EPO use was associated with increased risk of mortality and a trend toward increased cardiovascular events. Therefore, clinicians considering EPO use in CRAS patients should assess whether any potential benefits outweigh the risks of use.
authors: College of Pharmacy, Western University of Health Sciences, Pomona, California; Veteran Affairs Greater Los Angeles Healthcare System, Los Angeles, California; Institute for Clinical Evaluative Sciences, Toronto, Canada; Faculty of Medicine, University of Toronto, Institute for Health Policy, Management, and Evaluation, Toronto, Canada; University Health Network, Toronto, Canada. Electronic address: cjackevicius@westernu.edu.
authors: Cynthia A
authors: CA
authors: Jackevicius
authors: College of Pharmacy, Western University of Health Sciences, Pomona, California; Veteran Affairs Greater Los Angeles Healthcare System, Los Angeles, California.
authors: Cindy Shutieng
authors: CS
authors: Fan
authors: Veteran Affairs Greater Los Angeles Healthcare System, Los Angeles, California; Division of Cardiology, Department of Medicine, University of California, Los Angeles, California.
authors: Alberta
authors: A
authors: Warner
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D015331:Cohort Studies; D018572:Disease-Free Survival; D004921:Erythropoietin / Q000627:therapeutic use*; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D004921:Erythropoietin
keywords: Cardiac; health policy; outcome research