Treatment patterns in patients with heart failure and anemia: is there a bias?

Abstract

Anemia in heart failure (HF) patients (pts), defined as hemoglobin (Hb)<12 g/dL, is often sub-optimally evaluated and inconsistently treated. In an effort to define Health Care Providers (HCP) awareness and quantitate perceived thresholds for anemia treatment in HF pts, approximately 300 surveys that addressed the treatment patterns for patients with heart failure, anemia and other conditions were distributed during the 7th Annual Scientific Meeting of the Heart Failure Society of America in September 2003. A total of 155 surveys were completed, with a response rate 52%. HCP consisted of 102 physicians (66%) and 53 advanced practice professionals (34%). The survey contained 21 questions of which 10 were specific to the importance of anemia in HF pts. The survey queried the threshold of blood transfusion as well as the initiation and comfort level of utilizing an erythropoietic agent (EPO). As anemia may be associated with cancer and its treatment, the survey also addressed the extent of the HCP willingness to provide cardiovascular intervention to cancer pts. Results: Anemia was perceived as important or very important in 137 (88%) of respondents. With regard to prescribing an EPO agent, 117 (78%) were comfortable or very comfortable. The blood transfusion threshold was Hb≤8 g/dL in 102 (67%) and the EPO agent threshold was Hb≤10 g/dL in 88 (57%) of respondents. The majority of HCP were comfortable prescribing transfusions (n=89, 57%), EPO agent (n=109, 70%) and/or iron therapy (n=133, 85%). HCP believed anemia occurred in HF pts more than 11% of the time (n=123,79%), and 124 (80%) perceived anemia was important for prognosis. However, only 101 (65%) of HCP check Hb routinely. HPC who perceived anemia as very important and were comfortable prescribing an EPO agent were more likely to check Hb and initiate an EPO agent at higher Hb levels (p<0.01). Surprisingly, HCP are reluctant to utilize cardiac intervention according to treatment guidelines in eligible cancer pts. Furthermore HPC who are comfortable prescribing an EPO agent were more likely to adhere to these guidelines (p<0.01). Conclusions: The majority of HCP perceived anemia in heart failure as important, and were comfortable prescribing an EPO agent. However, greater than 30% seldom or never check hemoglobin. HPC who are comfortable prescribing an EPO agent were more likely to check hemoglobin and initiate EPO therapy. Patients with cancer as a comorbidity may not be treated with cardiac intervention using the same rigor as the guidelines suggest.