Effects of erythropoiesis-stimulating agents on heart failure patients with anemia: a meta-analysis.

Abstract

IntroductionHeart failure (HF) is always complicated with anemia and is associated with bad prognosis in this patient population. Several studies have assessed the potential role of erythropoietin-stimulating agent (ESA) in improving cardiac function and reducing the number of hospitalizations in anemic patients with HF.AimWe performed a meta-analysis to assess the potential role of ESA in the treatment of anemic patients with HF.Material and methodsA literature and Medline search was performed to identify studies with control groups that examined the efficacy of ESA therapy in patients with HF and anemia.ResultsA total of 11 studies were included (n = 3044 subjects) in the final analysis. Compared to placebo, ESA therapy was associated with increased hemoglobin levels (1.89 g/dl; 95% CI: 1.64–2.14, p < 0.00001), increased left ventricular ejection fraction (LVEF) to 6.88 (95% CI: 0.49–13.28, p = 0.03), decreased B-type natriuretic protein (–272.20; 95% CI: (–444.52)–(–99.89), p = 0.002), improvement in New York Heart Association functional class to –0.33 mean difference (95% CI: (–0.44)–(–0.23), p < 0.00001), and decreased hospitalization (OR = 0.61, 95% CI: 0.39–0.94, p = 0.02). There was no significant between-group difference in all-cause mortality (OR = 0.78, 95% CI: 0.51–1.21, p = 0.27).ConclusionsThe treatment of anemia with ESA therapy did not reduce the rate of all-cause mortality among patients with heart failure, but ESA therapy made a potential important contribution to patients’ symptomatic improvement.