Erythropoiesis Stimulating Agents in Heart Failure Patients with Anemia: A Meta-Analysis

  • Faramarz Tehrani
  • Pavittarpaul Dhesi
  • Daniel Daneshvar
  • Anita Phan
  • Asim Rafique
  • Robert J. Siegel
  • Bojan Cercek
Article

DOI: 10.1007/s10557-009-6203-6

Cite this article as:
Tehrani, F., Dhesi, P., Daneshvar, D. et al. Cardiovasc Drugs Ther (2009) 23: 511. doi:10.1007/s10557-009-6203-6

Abstract

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).

Conclusion

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.

Key words

Heart failure Anemia Erythropoietin 

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Faramarz Tehrani
    • 1
  • Pavittarpaul Dhesi
    • 1
  • Daniel Daneshvar
    • 1
  • Anita Phan
    • 1
  • Asim Rafique
    • 1
  • Robert J. Siegel
    • 1
  • Bojan Cercek
    • 1
  1. 1.Cedars-Sinai Heart InstituteCedars-Sinai Medical CenterLos AngelesUSA