Anemia and the potential role of erythropoiesis-stimulating agents in heart failure

Abstract

The recognition of the high prevalence and the independent prognostic role of anemia in heart failure (HF) has contributed to intensification of the search for an effective treatment. A central role of erythropoietin in cardiorenal anemia syndrome has been proposed. Several clinical trials have established the safety and efficacy of erythropoiesis-stimulating agents in correcting anemia in patients with HF. The recognition of the pleiotropic effect of erythropoietin has expanded targets of therapy. The ongoing outcomes trial with darbepoetin alfa will determine the role of this novel therapy in the treatment of HF.

Can Iron Play a Crucial Role in Maintaining Cardiovascular Health in the 21st Century?

“…Very severe anemia can cause HfpEF that results in an increase in Hb [71], leading to an increase in myocardial workload to compensate for the reduced tissue oxygen delivery. Some studies showed that erythropoetin (EPO) improves exercise capacity and NYHA class and reduces hospitalization [72]. Moreover, EPO can improve LVEF, right ventricular ejection fraction left ventricular function [73], as well as supress proinflammatiory citokines (TNF-alfa, IL-6) with an increase in antiinflammatory IL-10 [74].…”

Effect of Oral Iron Therapy on Clinical Outcomes in Patients With Heart Failure

“…Anemia is common in patients with HF and is associated with more severe symptoms 9, lower functional status, worse exercise capacity 9 ,cognitive impairment and worse quality of life. Preliminary open label studies in systolic HF have suggested that treatment with erythropoiesis stimulating agents leads to improvement in NYHA class, exercise capacity, cardiac and renal functions 10 . Anker et al 11 demonstrated that treatment with intravenous ferric carboxymaltose in patients with chronic HF improves symptoms, functional capacity and quality of life.…”