The Role of Anemia in the Progression of Congestive Heart Failure: Is There a Place for Erythropoietin and Intravenous Iron?

Abstract

SUMMARY Despite all the advances in congestive heart failure (CHF), the mortality, morbidity and the number of rehospitalizations in this condition is still very high, even if patients are given the recommended CHF medications in the recommended doses.We found that the majority of these refractory CHF patients were anemic, with hemoglobin concentrations less than 12 g/dL. In both uncontrolled and controlled studies, when we corrected their anemia with subcutaneous erythropoietin (EPO) and intravenous iron sucrose, we found that their cardiac functional status and cardiac function improved, their need for rehospitalization fell dramatically and their need for diuretics improved greatly. Their renal function, which had been deteriorating rapidly before correction of the anemia, generally stabilized or improved. Others subsequently found, in controlled studies using EPO, that cardiac function, as judged by oxygen utilization during peak exercise, also improved, as did exercise capacity and quality of life. Subsequently, many others have examined this relationship of anemia to the severity of CHF, the mortality rate and the hospitalization rate, and the great majority have confirmed our findings. A randomized controlled double-blind study is now being carried out on hundreds of severe, anemic CHF patients to ascertain the role of anemia correction is in CHF. If it verifies the preliminary optimistic results mentioned above, anemia management may become an important new therapy for the prevention of progression of CHF and the associated renal failure.