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Erythropoietin as a treatment of anemia in heart failure: Systematic review of randomized trials

Citation

Kotecha, D and Ngo, K and Walters, JAE and Manzano, L and Palazzuoli, A and Flather, MD, Erythropoietin as a treatment of anemia in heart failure: Systematic review of randomized trials, American Heart Journal: The International Publication for The Study of The Heart and Circulation, 161, (5) pp. 822-831. ISSN 0002-8703 (2011) [Refereed Article]


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Copyright © 2011 The definitive version is available at http://www.sciencedirect.com

DOI: doi:10.1016/j.ahj.2011.02.013

Abstract

Background Anemia in heart failure is both common and associated with worse symptoms and increased mortality. Several small randomized controlled trials (RCTs) have assessed erythropoiesis-stimulating agents (ESAs), but definitive evaluation and clinical guidance are required. We sought to systematically review the effects of ESAs in chronic heart failure. Methods An extensive search strategy identified 11 RCTs with 794 participants comparing any ESA with control over 2 to 12 months of follow-up. Published and additionally requested data were incorporated into a Cochrane systematic review (CD007613). Results Nine studies were placebo controlled, and 5, double blinded. Erythropoiesis-stimulating agent treatment significantly improved exercise duration by 96.8 seconds (95% CI 5.2-188.4, P = .04) and 6-minute walk distance by 69.3 m (95% CI 17.0-121.7, P = .009) compared with control. Benefit was also noted for peak oxygen consumption (+2.29 mL/kg per minute, P = .007), New York Heart Association class (−0.73, P b .001), ejection fraction (+5.8%, P b .001), B-type natriuretic peptide (−226.99 pg/mL, P b .001), and quality-of-life indicators with a mean increase in hemoglobin level of 2 g/dL. There was a significantly lower rate of heart failure–related hospitalizations with ESA therapy (odds ratio 0.56, 95% CI 0.37-0.84, P = .005). No associated increase in adverse events or mortality (odds ratio 0.58, 95% CI 0.34-0.99, P = .047) was observed, although the number of events was limited. Conclusion Meta-analysis of small RCTs suggests that ESA treatment can improve exercise tolerance, reduce symptoms, and have benefits on clinical outcomes in anemic patients with heart failure. Confirmation requires larger, well-designed studies with careful attention to dose, attained hemoglobin level, and long-term outcomes.

Item Details

Item Type:Refereed Article
Research Division:Medical and Health Sciences
Research Group:Cardiorespiratory Medicine and Haematology
Research Field:Cardiorespiratory Medicine and Haematology not elsewhere classified
Objective Division:Health
Objective Group:Clinical Health (Organs, Diseases and Abnormal Conditions)
Objective Field:Cardiovascular System and Diseases
Author:Ngo, K (Ms Katherine Ngo)
Author:Walters, JAE (Dr Julia Walters)
ID Code:71951
Year Published:2011
Web of Science® Times Cited:30
Deposited By:Menzies Institute for Medical Research
Deposited On:2011-08-16
Last Modified:2017-11-03
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