351
|
Lindquist DE, Cruz JL, Brown JN. Use of erythropoiesis-stimulating agents in the treatment of anemia in patients with systolic heart failure. J Cardiovasc Pharmacol Ther 2014; 20:59-65. [PMID: 24996902 DOI: 10.1177/1074248414541841] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine the efficacy and safety of erythropoiesis-stimulating agents (ESAs) for the treatment of anemia in patients with systolic heart failure. DATA SOURCES A search of MEDLINE (1946-January 2014) and EMBASE (1947-January 2014) was conducted using the search terms erythropoietin and systolic heart failure. In addition, bibliographies of relevant articles were reviewed for additional citations. STUDY SELECTION AND DATA EXTRACTION All English language randomized controlled trials evaluating clinical outcomes or adverse events when using ESAs in the setting of systolic heart failure were included. DATA SYNTHESIS A total of 9 studies were reviewed. All studies examining hematological parameters found a statistically significant increase in hemoglobin levels with active treatment versus placebo. Of the 7 trials evaluating exercise tolerance or capacity, only 4 demonstrated statistically significant improvement in these measures in patients receiving ESAs, whereas the remainder showed no clinical benefit. Four studies examined quality-of-life measures. Although numerical improvements were observed in most trials, statistical significance was reached in only 2 trials. A nonsignificant trend for decreased mortality in patients treated with darbepoetin with a similar adverse event profile compared to placebo was shown in one study; however, the largest trial to date showed no benefit in all-cause mortality or heart failure-related hospitalizations with the use of ESAs. Additionally, a statistically significant increase in the number of cerebrovascular events and thrombotic events was found. CONCLUSION There is inconclusive evidence to suggest that the use of ESAs in treating anemia in patients with heart failure is beneficial. Although ESAs demonstrated a clear ability for increasing hemoglobin levels, the data regarding clinical outcomes such as exercise parameters, quality of life, and hospitalizations are conflicting. In addition, a mortality benefit has not been shown; therefore, the potential for improved symptomatology must be weighed against the potential for adverse events.
Collapse
Affiliation(s)
- Desirae E Lindquist
- Department of Pharmacy Practice, Campbell University College of Pharmacy and Health Sciences, Buies Creek, NC, USA
| | - Jennifer L Cruz
- Geriatric Research, Education, and Clinical Center, Durham VA Medical Center, Durham, NC, USA
| | - Jamie N Brown
- Pharmacy Service, Durham VA Medical Center, Durham, NC, USA
| |
Collapse
|
352
|
Jackevicius CA, Co MJ, Warner AL. Predictors of erythropoietin use in patients with cardiorenal anaemia syndrome. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2014; 23:199-204. [DOI: 10.1111/ijpp.12133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 03/21/2014] [Indexed: 11/28/2022]
Abstract
Abstract
Objectives
Chronic kidney disease (CKD) and anemia are common in patients with heart failure (HF) – these 3 conditions have been coined the Cardiorenal Anemia Sydrome (CRAS). The National Kidney Foundation Kidney Disease Outcomes Quality Initiative (NKF-K/DOQI) guidelines do not specifically address patients with CRAS, creating uncertainty in erythropoietin (EPO) prescribing. We sought to determine predictors of EPO use in patients with CRAS.
Methods
We conducted a retrospective cohort study at the Veteran’s Affairs Greater Los Angeles Healthcare System (VAGLAHS), a 300+ bed facility that provides primary and tertiary inpatient, and ambulatory care services, between January 1, 2003 to December 31, 2006. A multiple logistic regression model was constructed to identify predictors of EPO use among CRAS patients.
Key findings
Of 2058 patients with CRAS, 213 (10.3%) were prescribed EPO. There were significant differences in baseline characteristics between the EPO and non-EPO groups. The following predictors were found to be associated with EPO prescription: iron supplementation (odds ratio [OR] 52.70, 95% confidence interval [CI] 11.70–237.46), renal clinic appointment (OR 2.60, 95% CI 1.79–3.76), malignancy (OR 1.52, 95% CI 1.07–2.16) and use of hydralazine/nitrates (OR 1.41, 95% CI 1.03–1.92). There was an inverse association found between EPO prescription and baseline hemoglobin (OR 0.61, 95% CI 0.53–0.70) and eGFR (OR 0.96, 95% CI 0.94–0.97).
Conclusion
A small proportion of patients eligible for EPO therapy according to guidelines at the time of the study were prescribed the indicated therapy. Markers of declining renal function or those suggesting need for anemia therapy were identified as EPO predictors.
Collapse
Affiliation(s)
- Cynthia A Jackevicius
- Pharmacy Practice and Administration Department, Western University of Health Sciences, Pomona, CA, USA
- Division of Cardiology, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Institute for Clinical Evaluative Sciences, University of Toronto, Toronto, ON, Canada
- Department of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Mary Joana Co
- Pharmacy Practice and Administration Department, Western University of Health Sciences, Pomona, CA, USA
- Pharmacy Department, Providence Saint Joseph Medical Center, Burbank, CA, USA
| | - Alberta L Warner
- Division of Cardiology, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Division of Cardiology, University of California, Los Angeles, CA, USA
| |
Collapse
|
353
|
|
354
|
McMurray JJV, Packer M, Desai AS, Gong J, Lefkowitz M, Rizkala AR, Rouleau JL, Shi VC, Solomon SD, Swedberg K, Zile MR. Baseline characteristics and treatment of patients in prospective comparison of ARNI with ACEI to determine impact on global mortality and morbidity in heart failure trial (PARADIGM-HF). Eur J Heart Fail 2014; 16:817-25. [PMID: 24828035 PMCID: PMC4312884 DOI: 10.1002/ejhf.115] [Citation(s) in RCA: 137] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 04/02/2014] [Indexed: 11/12/2022] Open
Abstract
AIM To describe the baseline characteristics and treatment of the patients randomized in the PARADIGM-HF (Prospective comparison of ARNi with ACEi to Determine Impact on Global Mortality and morbidity in Heart Failure) trial, testing the hypothesis that the strategy of simultaneously blocking the renin-angiotensin-aldosterone system and augmenting natriuretic peptides with LCZ696 200 mg b.i.d. is superior to enalapril 10 mg b.i.d. in reducing mortality and morbidity in patients with heart failure and reduced ejection fraction. METHODS Key demographic, clinical and laboratory findings, along with baseline treatment, are reported and compared with those of patients in the treatment arm of the Studies Of Left Ventricular Dysfunction (SOLVD-T) and more contemporary drug and device trials in heart failure and reduced ejection fraction. RESULTS The mean age of the 8442 patients in PARADIGM-HF is 64 (SD 11) years and 78% are male, which is similar to SOLVD-T and more recent trials. Despite extensive background therapy with beta-blockers (93% patients) and mineralocorticoid receptor antagonists (60%), patients in PARADIGM-HF have persisting symptoms and signs, reduced health related quality of life, a low LVEF (mean 29 ± SD 6%) and elevated N-terminal-proB type-natriuretic peptide levels (median 1608 inter-quartile range 886-3221 pg/mL). CONCLUSION PARADIGM-HF will determine whether LCZ696 is more beneficial than enalapril when added to other disease-modifying therapies and if further augmentation of endogenous natriuretic peptides will reduce morbidity and mortality in heart failure and reduced ejection fraction.
Collapse
Affiliation(s)
- John J V McMurray
- BHF Cardiovascular Research Centre, University of GlasgowGlasgow, Scotland, UK
| | - Milton Packer
- University of Texas Southwestern Medical CenterDallas, TX, USA
| | - Akshay S Desai
- Brigham and Women's Hospital, Cardiovascular MedicineMA, USA
| | - Jianjian Gong
- Novartis Pharmaceutical CorporationEast Hanover, NJ, USA
| | | | - Adel R Rizkala
- Novartis Pharmaceutical CorporationEast Hanover, NJ, USA
| | - Jean L Rouleau
- Université de Montréal, Institut de CardiologieMontréal, Canada
| | - Victor C Shi
- Novartis Pharmaceutical CorporationEast Hanover, NJ, USA
| | - Scott D Solomon
- Brigham and Women's Hospital, Cardiovascular MedicineMA, USA
| | - Karl Swedberg
- Department of Molecular and Clinical MedicineGothenburg, Sweden
| | - Michael R Zile
- The Medical University of South Carolina and RHJ Department of Veterans Administration Medical CenterCharleston, SC, USA
| |
Collapse
|
355
|
Mastromarino V, Musumeci MB, Conti E, Tocci G, Volpe M. Erythropoietin in cardiac disease: effective or harmful? J Cardiovasc Med (Hagerstown) 2014; 14:870-8. [PMID: 23811836 DOI: 10.2459/jcm.0b013e328362c6ae] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Discovered as the primary regulator of erythropoiesis, erythropoietin (EPO) is involved in a broad variety of processes that play a major role in cardiovascular diseases. In particular, the antiapoptotic and pro-angiogenic properties of EPO have prompted a growing interest in the use of EPO for the treatment of myocardial infarction and heart failure. In a variety of myocardial ischemic injury animal models, EPO administration has been shown to acutely reduce infarct size, thereby preserving ventricular function. In addition, cardiac long-term effects of EPO, such as prevention of ventricular remodeling and heart failure, have been described. In recent years, several trials have tested the effects of recombinant human erythropoietin (rhEPO) administration in patients with myocardial infarction and chronic heart failure, in the attempt to translate the cardioprotection found in experimental models to human patients. In view of the generally controversial findings, in this updated review we provide an overview of the results of the most recent trials that investigated the role of erythropoiesis-stimulating agents (ESAs), including rhEPO and its analogue darbepoetin, in the treatment of acute myocardial infarction and heart failure. The problems related to safety and tolerability of ESA therapy are also discussed. Our analysis of the available literature demonstrates that the results of clinical studies in patients with cardiac disease are not uniform and the conclusions are contradictory. Further larger prospective studies are required to test clinical efficacy and safety of EPO.
Collapse
Affiliation(s)
- Vittoria Mastromarino
- aCardiology Unit, Department of Clinical and Molecular Medicine, University 'Sapienza', Rome bIRCCS Neuromed Pozzilli (IS), Pozzilli, Italy
| | | | | | | | | |
Collapse
|
356
|
Pulignano G, Del Sindaco D, Di Lenarda A, Tinti MD, Tarantini L, Cioffi G, Tolone S, Pero G, Minardi G. Chronic renal dysfunction and anaemia are associated with cognitive impairment in older patients with heart failure. J Cardiovasc Med (Hagerstown) 2014; 15:481-90. [DOI: 10.2459/jcm.0000000000000005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
357
|
Savonitto S, Morici N, De Servi S. Update: acute coronary syndromes (VI): treatment of acute coronary syndromes in the elderly and in patients with comorbidities. ACTA ACUST UNITED AC 2014; 67:564-73. [PMID: 24952397 DOI: 10.1016/j.rec.2014.02.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 02/12/2014] [Indexed: 01/08/2023]
Abstract
Acute coronary syndromes have a wide spectrum of clinical presentations and risk of adverse outcomes. A distinction should be made between treatable (extent of ischemia, severity of coronary disease and acute hemodynamic deterioration) and untreatable risk (advanced age, prior myocardial damage, chronic kidney dysfunction, other comorbidities). Most of the patients with "untreatable" risk have been excluded from the "guideline-generating" clinical trials. In recent years, despite the paucity of specific randomized trials, major advances have been completed in the management of elderly patients and patients with comorbidities: from therapeutic nihilism to careful titration of antithrombotic agents, a shift toward the radial approach to percutaneous coronary interventions, and also to less-invasive cardiac surgery. Further advances should be expected from the development of drug regimens suitable for use in the elderly and in patients with renal dysfunction, from a systematic multidisciplinary approach to the management of patents with diabetes mellitus and anemia, and from the courage to undertake randomized trials involving these high-risk populations.
Collapse
Affiliation(s)
| | - Nuccia Morici
- Cardiologia Prima-Emodinamica, Ospedale Niguarda Ca' Granda, Milano, Italy
| | - Stefano De Servi
- Cure Intensive Coronariche, IRCCS Policlinico S. Matteo, Pavia, Italy
| |
Collapse
|
358
|
Differences in blood volume components between hyporesponders and responders to erythropoietin alfa: the heart failure with preserved ejection fraction (HFPEF) anemia trial. J Card Fail 2014; 19:685-91. [PMID: 24125107 DOI: 10.1016/j.cardfail.2013.08.508] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 08/14/2013] [Accepted: 08/27/2013] [Indexed: 11/20/2022]
Abstract
BACKGROUND Hyporesponders to erythropoietin-stimulating agents (ESAs) have been associated with an increased subsequent risk of death or cardiovascular events. We hypothesized that subjects who are hyporesponsive to erythropoietin alfa would have higher plasma volumes and lower red cell deficits than subjects who are responsive to therapy. METHODS As part of a prospective, single blind, randomized, placebo-controlled study comparing erythropoietin alfa with placebo in older adults (n = 56) with heart failure and a preserved ejection fraction (HFPEF), we performed blood volume analysis with the use of an indicator dilution technique with (131)iodine-labeled albumin. We evaluated differences in plasma volumes and red cell volumes in hyporesponders (eg, <1 g/dL increase in hemoglobin within the first 4 weeks of treatment with erythropoetin alfa) compared with subjects who were responders and controls. RESULTS Nine of 28 subjects (32%) assigned to ESA were hyporesponders. Hyporesponders did not differ from responders nor control subjects by any baseline demographic, clinical, or laboratory parameter, including hemoglobin. Hyporesponders had a greater total blood volume expansion (1,264.7 ± 387 vs 229 ± 206 mL; P = .02) but less of a red cell deficit (-96.2 ± 126 vs -402.5 ± 80.6 mL; P = .04) and a greater plasma volume expansion (+1,360.8 ± 264.5 vs +601.1 ± 165.5 mL; P = .01). Among responders, the increase in hemoglobin with erythropoietin alfa was associated primarily with increases in red cell volume (r = 0.91; P < .0001) as well as a decline in plasma volume (r = -0.55; P = .06). CONCLUSIONS Among older adults with HFPEF and anemia, hyporesponders to erythropoietin alfa had a hemodilutional basis of their anemia, suggesting that blood volume analysis can identify a cohort likely to respond to therapy.
Collapse
|
359
|
Dunlay SM, Pereira NL, Kushwaha SS. Contemporary strategies in the diagnosis and management of heart failure. Mayo Clin Proc 2014; 89:662-76. [PMID: 24684781 PMCID: PMC4922303 DOI: 10.1016/j.mayocp.2014.01.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 01/02/2014] [Accepted: 01/06/2014] [Indexed: 12/20/2022]
Abstract
Heart failure (HF) is an important public health problem, and strategies are needed to improve outcomes and decrease health care resource utilization and costs. Its prevalence has increased as the population ages, and HF continues to be associated with a high mortality rate and frequent need for hospitalization. The total cost of care for patients with HF was $30.7 billion in 2012, and it is estimated to more than double to $69.8 billion by 2030. Given this reality, there has been recent investigation into ways of identifying and preventing HF in patients at risk (stage A HF) and those with cardiac structural and functional abnormalities but no clinical HF symptoms (stage B). For patients who have symptoms of HF (stage C), there has been important research into the most effective ways to decongest patients hospitalized with acute decompensated HF and prevent future hospital readmissions. Successful strategies to treat patients with HF and preserved ejection fraction, which has increased in prevalence, continue to be sought. We are in the midst of a rapid evolution in our ability to care for patients with end-stage HF (stage D) because of the introduction of and improvements in mechanical circulatory support. Left ventricular assist devices used as destination therapy offer an important therapeutic option to patients who do not qualify for heart transplant because of advanced age or excessive comorbidity. This review provides a thorough update on contemporary strategies in the diagnosis and management of HF by stage (A to D) that have emerged during the past several years.
Collapse
Affiliation(s)
- Shannon M Dunlay
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN; Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
| | - Naveen L Pereira
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Sudhir S Kushwaha
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| |
Collapse
|
360
|
Subirana MT, Barón-Esquivias G, Manito N, Oliver JM, Ripoll T, Lambert JL, Zunzunegui JL, Bover R, García-Pinilla JM. 2013 update on congenital heart disease, clinical cardiology, heart failure, and heart transplant. ACTA ACUST UNITED AC 2014; 67:211-7. [PMID: 24774396 DOI: 10.1016/j.rec.2013.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Accepted: 10/02/2013] [Indexed: 11/25/2022]
Abstract
This article presents the most relevant developments in 2013 in 3 key areas of cardiology: congenital heart disease, clinical cardiology, and heart failure and transplant. Within the area of congenital heart disease, we reviewed contributions related to sudden death in adult congenital heart disease, the importance of specific echocardiographic parameters in assessing the systemic right ventricle, problems in patients with repaired tetralogy of Fallot and indication for pulmonary valve replacement, and confirmation of the role of specific factors in the selection of candidates for Fontan surgery. The most recent publications in clinical cardiology include a study by a European working group on correct diagnostic work-up in cardiomyopathies, studies on the cost-effectiveness of percutaneous aortic valve implantation, a consensus document on the management of type B aortic dissection, and guidelines on aortic valve and ascending aortic disease. The most noteworthy developments in heart failure and transplantation include new American guidelines on heart failure, therapeutic advances in acute heart failure (serelaxin), the management of comorbidities such as iron deficiency, risk assessment using new biomarkers, and advances in ventricular assist devices.
Collapse
Affiliation(s)
- M Teresa Subirana
- Unidad de Cardiopatías Congénitas del Adolescente y Adulto Vall d'Hebron-Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
| | | | - Nicolás Manito
- Unidad de Insuficiencia Cardiaca y Trasplante Cardiaco, Hospital Universitario de Bellvitge, L'Hospitalet del Llobregat, Barcelona, Spain
| | - José M Oliver
- Unidad de Cardiopatías Congénitas del Adulto, Hospital La Paz, Madrid, Spain
| | - Tomás Ripoll
- Unidad de Cardiopatías Familiares, Servicio de Cardiología, Hospital Son Llàtzer, Palma de Mallorca, Spain
| | - Jose Luis Lambert
- Unidad de Insuficiencia Cardiaca Avanzada y Trasplante Cardiaco del Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - José L Zunzunegui
- Unidad de Cardiología Pediátrica, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ramon Bover
- Unidad de Insuficiencia Cardiaca, Servicio de Cardiología, Hospital Clínico Universitario San Carlos Madrid, Spain
| | - José Manuel García-Pinilla
- Unidad de Insuficiencia Cardiaca y Cardiopatías Familiares, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| |
Collapse
|
361
|
Fokkema ML, Kleijn L, van der Meer P, Belonje AM, Achterhof SK, Hillege HL, van 't Hof A, Jukema JW, Peels HO, Henriques JP, ten Berg JM, Vos J, van Gilst WH, van Veldhuisen DJ, Voors AA. Long term effects of epoetin alfa in patients with ST- elevation myocardial infarction. Cardiovasc Drugs Ther 2014; 27:433-9. [PMID: 23784615 DOI: 10.1007/s10557-013-6470-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE The HEBE III trial showed that epoetin alfa administration in patients with a first ST-elevation myocardial infarction (STEMI) did not improve left ventricular function at 6 weeks after primary percutaneous coronary intervention (PCI). The long term effects of erythropoiesis- stimulating agents on cardiovascular morbidity and mortality are unknown, therefore we evaluated clinical events at 1 year after PCI. METHODS A total of 529 patients with a first STEMI and successful primary PCI were randomized to standard optimal medical treatment (N = 266) or an additional bolus of 60,000 IU epoetin alfa administered intravenously (N = 263) within 3 h after PCI. Analyses were performed by intention to treat. RESULTS At 1 year after STEMI, 485 patients had complete follow-up. The rate of the composite end point of all-cause mortality, re-infarction, target vessel revascularization, stroke and/or heart failure was 6.4 % (N = 15) in the epoetin alfa group and 9.6 % (N = 24) in the control group (p = 0.18). Thromboembolic events were present in 1.3 % (N = 3) of patients in the epoetin alfa group and 2.4 % (N = 6) in the control group. There was no evidence of benefit from epoetin alfa administration in subgroups of patients. CONCLUSIONS Administration of a single bolus of epoetin alfa in patients with STEMI does not result in a reduction of cardiovascular events at 1 year after primary PCI. There was a comparable incidence of thromboembolic complications in both treatment groups, suggesting that epoetin alfa administration is safe at long term.
Collapse
Affiliation(s)
- Marieke L Fokkema
- Department of Cardiology, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
362
|
Mentz RJ, Greene SJ, Ambrosy AP, Vaduganathan M, Subacius HP, Swedberg K, Maggioni AP, Nodari S, Ponikowski P, Anker SD, Butler J, Gheorghiade M. Clinical profile and prognostic value of anemia at the time of admission and discharge among patients hospitalized for heart failure with reduced ejection fraction: findings from the EVEREST trial. Circ Heart Fail 2014; 7:401-8. [PMID: 24737459 DOI: 10.1161/circheartfailure.113.000840] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Anemia has been associated with worse outcomes in patients with chronic heart failure (HF). We aimed to characterize the clinical profile and postdischarge outcomes of hospitalized HF patients with anemia at admission or discharge. METHODS AND RESULTS An analysis was performed on 3731 (90%) of 4133 hospitalized HF patients with ejection fraction ≤40% enrolled in the Efficacy of Vasopressin Antagonist in Heart Failure Outcome Study with Tolvaptan (EVEREST) trial with baseline hemoglobin data, comparing the clinical characteristics and outcomes (all-cause mortality and cardiovascular mortality or HF hospitalization) of patients with and without anemia (hemoglobin <12 g/dL for women and <13 g/dL for men) on admission or discharge/day 7. Overall, 1277 patients (34%) were anemic at baseline, which persisted through discharge in 73% and resolved in 27%; 6% of patients without baseline anemia developed anemia by discharge or day 7. Patients with anemia were older, with lower blood pressure, and higher creatinine and natriuretic peptide levels compared with those without anemia (all P<0.05). After risk adjustment, anemia at discharge, but not admission, was independently associated with increased all-cause mortality (hazard ratio, 1.30; 95% confidence interval, 1.05-1.60; P=0.015; and hazard ratio, 0.94; 95% confidence interval, 0.76-1.15; P=0.53, respectively) and cardiovascular mortality plus HF hospitalization early postdischarge (≤100 days; hazard ratio 1.73; 95% confidence interval, 1.37-2.18; P<0.001; and hazard ratio, 0.92; 95% confidence interval, 0.73-1.16; P=0.47, respectively). Neither baseline nor discharge anemia was associated with long-term cardiovascular mortality plus HF hospitalization (>100 days) on adjusted analysis (both P>0.1). CONCLUSIONS Among hospitalized HF patients with reduced ejection fraction, modest anemia at discharge but not baseline was associated with increased all-cause mortality and short-term cardiovascular mortality plus HF hospitalization. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00071331.
Collapse
Affiliation(s)
- Robert J Mentz
- From the Duke University Medical Center, Durham, NC (R.J.M.); Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.G.); Stanford University School of Medicine, CA (A.P.A.); Massachusetts General Hospital, Boston (M.V.); Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, IL (H.P.S., M.G.); Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden (K.S.); Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy (A.P.M.); University of Brescia, Brescia, Italy; Klinika Kardiologii, Wroclaw, Poland (S.N., P.P.); Center for Clinical and Basic Research, IRCCS San Raffaele, Rome, Italy (S.D.A.); and Emory University, Atlanta, GA (J.B.)
| | - Stephen J Greene
- From the Duke University Medical Center, Durham, NC (R.J.M.); Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.G.); Stanford University School of Medicine, CA (A.P.A.); Massachusetts General Hospital, Boston (M.V.); Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, IL (H.P.S., M.G.); Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden (K.S.); Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy (A.P.M.); University of Brescia, Brescia, Italy; Klinika Kardiologii, Wroclaw, Poland (S.N., P.P.); Center for Clinical and Basic Research, IRCCS San Raffaele, Rome, Italy (S.D.A.); and Emory University, Atlanta, GA (J.B.)
| | - Andrew P Ambrosy
- From the Duke University Medical Center, Durham, NC (R.J.M.); Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.G.); Stanford University School of Medicine, CA (A.P.A.); Massachusetts General Hospital, Boston (M.V.); Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, IL (H.P.S., M.G.); Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden (K.S.); Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy (A.P.M.); University of Brescia, Brescia, Italy; Klinika Kardiologii, Wroclaw, Poland (S.N., P.P.); Center for Clinical and Basic Research, IRCCS San Raffaele, Rome, Italy (S.D.A.); and Emory University, Atlanta, GA (J.B.)
| | - Muthiah Vaduganathan
- From the Duke University Medical Center, Durham, NC (R.J.M.); Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.G.); Stanford University School of Medicine, CA (A.P.A.); Massachusetts General Hospital, Boston (M.V.); Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, IL (H.P.S., M.G.); Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden (K.S.); Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy (A.P.M.); University of Brescia, Brescia, Italy; Klinika Kardiologii, Wroclaw, Poland (S.N., P.P.); Center for Clinical and Basic Research, IRCCS San Raffaele, Rome, Italy (S.D.A.); and Emory University, Atlanta, GA (J.B.)
| | - Haris P Subacius
- From the Duke University Medical Center, Durham, NC (R.J.M.); Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.G.); Stanford University School of Medicine, CA (A.P.A.); Massachusetts General Hospital, Boston (M.V.); Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, IL (H.P.S., M.G.); Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden (K.S.); Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy (A.P.M.); University of Brescia, Brescia, Italy; Klinika Kardiologii, Wroclaw, Poland (S.N., P.P.); Center for Clinical and Basic Research, IRCCS San Raffaele, Rome, Italy (S.D.A.); and Emory University, Atlanta, GA (J.B.)
| | - Karl Swedberg
- From the Duke University Medical Center, Durham, NC (R.J.M.); Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.G.); Stanford University School of Medicine, CA (A.P.A.); Massachusetts General Hospital, Boston (M.V.); Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, IL (H.P.S., M.G.); Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden (K.S.); Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy (A.P.M.); University of Brescia, Brescia, Italy; Klinika Kardiologii, Wroclaw, Poland (S.N., P.P.); Center for Clinical and Basic Research, IRCCS San Raffaele, Rome, Italy (S.D.A.); and Emory University, Atlanta, GA (J.B.)
| | - Aldo P Maggioni
- From the Duke University Medical Center, Durham, NC (R.J.M.); Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.G.); Stanford University School of Medicine, CA (A.P.A.); Massachusetts General Hospital, Boston (M.V.); Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, IL (H.P.S., M.G.); Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden (K.S.); Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy (A.P.M.); University of Brescia, Brescia, Italy; Klinika Kardiologii, Wroclaw, Poland (S.N., P.P.); Center for Clinical and Basic Research, IRCCS San Raffaele, Rome, Italy (S.D.A.); and Emory University, Atlanta, GA (J.B.)
| | - Savina Nodari
- From the Duke University Medical Center, Durham, NC (R.J.M.); Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.G.); Stanford University School of Medicine, CA (A.P.A.); Massachusetts General Hospital, Boston (M.V.); Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, IL (H.P.S., M.G.); Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden (K.S.); Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy (A.P.M.); University of Brescia, Brescia, Italy; Klinika Kardiologii, Wroclaw, Poland (S.N., P.P.); Center for Clinical and Basic Research, IRCCS San Raffaele, Rome, Italy (S.D.A.); and Emory University, Atlanta, GA (J.B.)
| | - Piotr Ponikowski
- From the Duke University Medical Center, Durham, NC (R.J.M.); Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.G.); Stanford University School of Medicine, CA (A.P.A.); Massachusetts General Hospital, Boston (M.V.); Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, IL (H.P.S., M.G.); Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden (K.S.); Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy (A.P.M.); University of Brescia, Brescia, Italy; Klinika Kardiologii, Wroclaw, Poland (S.N., P.P.); Center for Clinical and Basic Research, IRCCS San Raffaele, Rome, Italy (S.D.A.); and Emory University, Atlanta, GA (J.B.)
| | - Stefan D Anker
- From the Duke University Medical Center, Durham, NC (R.J.M.); Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.G.); Stanford University School of Medicine, CA (A.P.A.); Massachusetts General Hospital, Boston (M.V.); Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, IL (H.P.S., M.G.); Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden (K.S.); Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy (A.P.M.); University of Brescia, Brescia, Italy; Klinika Kardiologii, Wroclaw, Poland (S.N., P.P.); Center for Clinical and Basic Research, IRCCS San Raffaele, Rome, Italy (S.D.A.); and Emory University, Atlanta, GA (J.B.)
| | - Javed Butler
- From the Duke University Medical Center, Durham, NC (R.J.M.); Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.G.); Stanford University School of Medicine, CA (A.P.A.); Massachusetts General Hospital, Boston (M.V.); Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, IL (H.P.S., M.G.); Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden (K.S.); Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy (A.P.M.); University of Brescia, Brescia, Italy; Klinika Kardiologii, Wroclaw, Poland (S.N., P.P.); Center for Clinical and Basic Research, IRCCS San Raffaele, Rome, Italy (S.D.A.); and Emory University, Atlanta, GA (J.B.)
| | - Mihai Gheorghiade
- From the Duke University Medical Center, Durham, NC (R.J.M.); Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.G.); Stanford University School of Medicine, CA (A.P.A.); Massachusetts General Hospital, Boston (M.V.); Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, IL (H.P.S., M.G.); Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden (K.S.); Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy (A.P.M.); University of Brescia, Brescia, Italy; Klinika Kardiologii, Wroclaw, Poland (S.N., P.P.); Center for Clinical and Basic Research, IRCCS San Raffaele, Rome, Italy (S.D.A.); and Emory University, Atlanta, GA (J.B.).
| |
Collapse
|
363
|
Abstract
Treatment escalation of chronic systolic heart failure depends on left ventricular function and symptoms of the patients. In symptomatic patients with severely reduced left ventricular function (ejection fraction ≤ 30 %), the following therapeutic approaches are recommended: (1) angiotensin-converting enzyme (ACE) inhibitors (angiotensin receptor blocker in case of ACE inhibitor intolerance); (2) β-blockers; (3) mineralocorticoid receptor antagonists; (4) diuretics in case of signs and symptoms of congestion; (5) digitalis, in particular in patients with atrial fibrillation; (6) ivabradine in patients with sinus rhythm and a heart rate ≥ 75/min; (7) an implantable cardioverter defibrillator (ICD); (8) in case of left bundle branch block or wide QRS complex, cardiac resynchronization therapy (CRT; in most cases in combination with an implantable cardioverter defibrillator); (9) intravenous administration of iron in case of iron deficiency; (10) exercise training should be strongly recommended in patients with stable heart failure.
Collapse
|
364
|
|
365
|
Beavers CJ, Alburikan KA, Rodgers JE, Dunn SP, Reed BN. Distinguishing Anemia and Iron Deficiency of Heart Failure: Signal for Severity of Disease or Unmet Therapeutic Need? Pharmacotherapy 2014; 34:719-32. [DOI: 10.1002/phar.1412] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Craig J. Beavers
- Department of Pharmacy; TriStar Centennial Medical Center; Nashville Tennessee
| | - Khalid A. Alburikan
- Eshelman School of Pharmacy; University of North Carolina at Chapel Hill; Chapel Hill North Carolina
| | - Jo E. Rodgers
- Eshelman School of Pharmacy; University of North Carolina at Chapel Hill; Chapel Hill North Carolina
| | - Steven P. Dunn
- Department of Pharmacy Services; University of Virginia Health System; Charlottesville Virginia
| | - Brent N. Reed
- School of Pharmacy; University of Maryland; Baltimore Maryland
| |
Collapse
|
366
|
Subirana MT, Barón-Esquivias G, Manito N, Oliver JM, Ripoll T, Lambert JL, Zunzunegui JL, Bover R, García-Pinilla JM. Actualización 2013 en cardiopatías congénitas, cardiología clínica e insuficiencia cardiaca y trasplante. Rev Esp Cardiol 2014. [DOI: 10.1016/j.recesp.2013.10.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
367
|
Robles Perez-Monteoliva NR, Macías Núñez JF, Herrera Pérez de Villar J. Uso de agentes estimuladores de la eritropoyesis en pacientes con insuficiencia cardiaca congestiva. Med Clin (Barc) 2014; 142:215-8. [DOI: 10.1016/j.medcli.2013.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2013] [Revised: 06/05/2013] [Accepted: 06/13/2013] [Indexed: 11/25/2022]
|
368
|
Silverberg DS, Mor R, Weu MT, Schwartz D, Schwartz IF, Chernin G. Anemia and iron deficiency in COPD patients: prevalence and the effects of correction of the anemia with erythropoiesis stimulating agents and intravenous iron. BMC Pulm Med 2014; 14:24. [PMID: 24564844 PMCID: PMC3946070 DOI: 10.1186/1471-2466-14-24] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Accepted: 02/19/2014] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Little is known about iron deficiency (ID) and anemia in Chronic Obstructive Pulmonary Disease (COPD). The purposes of this study were: (i) To study the prevalence and treatment of anemia and ID in patients hospitalized with an exacerbation of COPD. (ii) to study the hematological responses and degree of dyspnea before and after correction of anemia with subcutaneous Erythropoiesis Stimulating Agents (ESAs) and intravenous (IV) iron therapy, in ambulatory anemic patients with both COPD and chronic kidney disease. METHODS (i) We examined the hospital records of all patients with an acute exacerbation of COPD (AECOPD) to assess the investigation, prevalence, and treatment of anemia and ID. (ii) We treated 12 anemic COPD outpatients with the combination of ESAs and IV-iron, given once weekly for 5 weeks. One week later we measured the hematological response and the severity of dyspnea by Visual Analogue Scale (VAS). RESULTS (i) Anemia and iron deficiency in hospitalized COPD patients: Of 107 consecutive patients hospitalized with an AECOPD, 47 (43.9%) were found to be anemic on admission. Two (3.3%) of the 60 non-anemic patients and 18 (38.3%) of the 47 anemic patients had serum iron, percent transferrin saturation (%Tsat) and serum ferritin measured. All 18 (100%) anemic patients had ID, yet none had oral or IV iron subscribed before or during hospitalization, or at discharge. (ii) Intervention outpatient study: ID was found in 11 (91.7%) of the 12 anemic ambulatory patients. Hemoglobin (Hb), Hematocrit (Hct) and the VAS scale scores increased significantly with the ESAs and IV-iron treatment. There was a highly significant correlation between the ∆Hb and ∆VAS; rs = 0.71 p = 0.009 and between the ∆Hct and ∆VAS; rs = 0.8 p = 0.0014. CONCLUSIONS ID is common in COPD patients but is rarely looked for or treated. Yet correction of the ID in COPD patients with ESAs and IV iron can improve the anemia, the ID, and may improve the dyspnea.
Collapse
Affiliation(s)
- Donald S Silverberg
- Nephrology Department, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ram Mor
- Pulmonology Institute, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Melanie Tia Weu
- Department of Nephrology, CHU de Yopougon Hospital, Abidjan, Ivory Coast
| | - Doron Schwartz
- Nephrology Department, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Idit F Schwartz
- Nephrology Department, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Gil Chernin
- Nephrology Department, Tel-Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| |
Collapse
|
369
|
Jackevicius CA, Fan CS, Warner A. Clinical outcomes of erythropoietin use in heart failure patients with anemia of chronic kidney disease. J Card Fail 2014; 20:327-33. [PMID: 24530942 DOI: 10.1016/j.cardfail.2014.02.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 02/05/2014] [Accepted: 02/06/2014] [Indexed: 12/17/2022]
Abstract
BACKGROUND Anemia and chronic kidney disease are common disorders in heart failure (HF) patients and are associated with increased morbidity and mortality. This study assessed clinical outcomes associated with erythropoietin (EPO) treatment in this cardiorenal anemia syndrome (CRAS) population. METHODS AND RESULTS This was a retrospective cohort study of Veterans Affairs patients with CRAS from January 2003 to December 2006. The primary outcome was a composite of death, acute coronary syndrome (ACS), HF, and stroke. Multiple Cox regression modeling was used to evaluate the outcome in patients prescribed (n = 213) and not prescribed EPO (n = 1845). Adjusted incidence of mortality was statistically significantly higher in EPO than in non-EPO users (33.8% vs 19.7%; hazard ratio 1.40, 95% confidence interval 1.06-1.85; P = .02). The unadjusted composite of cardiovascular events/death was higher in the EPO group, but not statistically significant when adjusted for confounders (P = .12). Crude ACS events were documented in 18.8% and 10.8% patients (P = .001), and stroke events occurred in 22.5% and 18.3% patients (P = .14) in EPO and non-EPO groups, respectively. CONCLUSIONS We found that in CRAS patients, EPO use was associated with increased risk of mortality and a trend toward increased cardiovascular events. Therefore, clinicians considering EPO use in CRAS patients should assess whether any potential benefits outweigh the risks of use.
Collapse
Affiliation(s)
- Cynthia A Jackevicius
- College of Pharmacy, Western University of Health Sciences, Pomona, California; Veteran Affairs Greater Los Angeles Healthcare System, Los Angeles, California; Institute for Clinical Evaluative Sciences, Toronto, Canada; Faculty of Medicine, University of Toronto, Institute for Health Policy, Management, and Evaluation, Toronto, Canada; University Health Network, Toronto, Canada.
| | - Cindy Shutieng Fan
- College of Pharmacy, Western University of Health Sciences, Pomona, California; Veteran Affairs Greater Los Angeles Healthcare System, Los Angeles, California
| | - Alberta Warner
- Veteran Affairs Greater Los Angeles Healthcare System, Los Angeles, California; Division of Cardiology, Department of Medicine, University of California, Los Angeles, California
| |
Collapse
|
370
|
Gombotz H, Hofmann A. [Patient Blood Management : three pillar strategy to improve outcome through avoidance of allogeneic blood products]. Anaesthesist 2014; 62:519-27. [PMID: 23836145 DOI: 10.1007/s00101-013-2199-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Blood transfusions are commonly viewed as life-saving interventions; however, current evidence shows that blood transfusions are associated with a significant increase of morbidity and mortality in a dose-dependent relationship. Not only explanatory models of basic research but also the results from randomized controlled trials suggest a causal relationship between blood transfusion and adverse outcome. Therefore, it can be claimed that the current state of science debunks the long held belief in the so-called life-saving blood transfusion by exposing the potential for promoting disease and death. Adherence to the precautionary principle and also the fact that blood transfusions are more costly than previously assumed require novel approaches in the treatment of anemia and bleeding. Patient Blood Management (PBM) allows transfusion rates to be dramatically reduced through correcting anemia by stimulating erythropoiesis, minimization of perioperative blood loss and harnessing and optimizing the physiological tolerance of anemia. A resolution of the World Health Assembly has endorsed PBM and therefore morbidity and mortality should be significantly reduced by lowering of the currently high blood utilization rate of allogeneic blood products in Austria, Germany and Switzerland.
Collapse
Affiliation(s)
- H Gombotz
- Abteilung für Anästhesiologie und Intensivmedizin, Allgemeines Krankenhaus der Stadt Linz, Krankenhausstr. 9, 4020, Linz, Österreich.
| | | |
Collapse
|
371
|
Valentova M, von Haehling S. An overview of recent developments in the treatment of heart failure: update from the ESC Congress 2013. Expert Opin Investig Drugs 2014; 23:573-8. [DOI: 10.1517/13543784.2014.881799] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
|
372
|
Robles NR, Macias JF, Herrera J. Erythropoiesis stimulating agents (ESAs) for congestive heart failure: the red and the black. Eur J Intern Med 2014; 25:193-6. [PMID: 24491240 DOI: 10.1016/j.ejim.2013.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Revised: 09/11/2013] [Accepted: 12/24/2013] [Indexed: 10/25/2022]
Abstract
CHF is a disease of high incidence and prevalence in the elderly. Anemia is associated with an increased mortality in these patients. Erythropoietin secretion is reduced in these patients due to complexed mechanisms. Although some improvement in quality of life has been shown when using ESAs it has not been found any decrement on mortality. Moreover, safety reports suggest an increased risk of thromboembolic event. Together with the high drug cost, the use of ESAs cannot be recommended for the treatment of CHF patients.
Collapse
Affiliation(s)
| | | | - Julio Herrera
- Servicio de Nefrología, Hospital General de Asturias, Spain
| |
Collapse
|
373
|
Kleijn L, Westenbrink BD, van der Meer P. Erythropoietin and heart failure: the end of a promise? Eur J Heart Fail 2014; 15:479-81. [DOI: 10.1093/eurjhf/hft058] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Lennaert Kleijn
- Department of Cardiology; University Medical Center Groningen; Groningen The Netherlands
| | - B. Daan Westenbrink
- Department of Cardiology; University Medical Center Groningen; Groningen The Netherlands
| | - Peter van der Meer
- Department of Cardiology; University Medical Center Groningen; Groningen The Netherlands
| |
Collapse
|
374
|
Affiliation(s)
- Elapulli S. Prakash
- Division of Basic Medical Sciences; Mercer University School of Medicine; 1550 College Street Macon GA 31207 USA
| |
Collapse
|
375
|
Messori A, Fadda V, Maratea D, Trippoli S. Erythropoiesis-stimulating agents in heart failure: no proof of effectiveness or proof of no effectiveness? Eur J Heart Fail 2014; 15:944-5. [DOI: 10.1093/eurjhf/hft091] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Andrea Messori
- HTA Unit, Area Vasta Centro Toscana; Regional Health System, Via Guimaraes; 9-11, 59100 Prato Italy
| | - Valeria Fadda
- HTA Unit, ESTAV Toscana Centro; Regional Health Service; Firenze Italy
| | - Dario Maratea
- HTA Unit, ESTAV Toscana Centro; Regional Health Service; Firenze Italy
| | - Sabrina Trippoli
- HTA Unit, ESTAV Toscana Centro; Regional Health Service; Firenze Italy
| |
Collapse
|
376
|
Hohl M, Ardehali H, Azuaje FJ, Breckenridge RA, Doehner W, Eaton P, Ehret GB, Fujita T, Gaetani R, Giacca M, Hasenfuß G, Heymans S, Leite-Moreira AF, Linke WA, Linz D, Lyon A, Mamas MA, Orešič M, Papp Z, Pedrazzini T, Piepoli M, Prosser B, Rizzuto R, Tarone G, Tian R, van Craenenbroeck E, van Rooij E, Wai T, Weiss G, Maack C. Meeting highlights from the 2013 European Society of Cardiology Heart Failure Association Winter Meeting on Translational Heart Failure Research. Eur J Heart Fail 2014; 16:6-14. [PMID: 24453095 DOI: 10.1002/ejhf.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Revised: 09/07/2013] [Accepted: 09/09/2013] [Indexed: 11/09/2022] Open
Affiliation(s)
- Mathias Hohl
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, D-66421, Homburg/Saar, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
377
|
Abstract
Sleep-disordered breathing (SDB) is prevalent in patients with heart failure, and is associated with increased morbidity and mortality. SDB is proinflammatory, with nocturnal oxygen desaturations and hypercapnia appearing to play a pivotal role in the development of oxidative stress and sympathetic activation. Preliminary data suggest that attention to the diagnosis and management of SDB in patients with heart failure may improve outcomes. Ongoing research into the roles of comorbidities such as SDB as a treatment target may lead to better clinical outcomes and improved quality of life for patients with heart failure.
Collapse
Affiliation(s)
- Robert J Mentz
- Duke University Medical Center, Duke Clinical Research Institute, 2301 Erwin Road, Durham, NC 27710, USA.
| | - Mona Fiuzat
- Duke University Medical Center, Duke Clinical Research Institute, 2301 Erwin Road, Durham, NC 27710, USA
| |
Collapse
|
378
|
Abstract
There are still many aspects of heart failure care for which gaps remain in the evidence base, resulting in gaps in the guidelines. We aim to highlight these guideline gaps including areas that warrant further research and other areas where new data are forthcoming.
Collapse
Affiliation(s)
- Bao Tran
- Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center, Los Angeles, California, US
| | - Gregg C Fonarow
- Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center, Los Angeles, California, US
| |
Collapse
|
379
|
Gil VM, Ferreira JS. Anemia and iron deficiency in heart failure. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2014. [DOI: 10.1016/j.repce.2013.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
380
|
Fujino T, Kinugawa K, Hatano M, Imamura T, Muraoka H, Minatsuki S, Inaba T, Maki H, Kinoshita O, Nawata K, Yao A, Ono M, Komuro I. Low Blood Pressure, Low Serum Cholesterol and Anemia Predict Early Necessity of Ventricular Assist Device Implantation in Patients With Advanced Heart Failure at the Time of Referral From Non-Ventricular Assist Device Institutes. Circ J 2014. [DOI: 10.1253/circj.cj-14-0749] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Takeo Fujino
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
| | - Koichiro Kinugawa
- Department of Therapeutic Strategy for Heart Failure, Graduate School of Medicine, University of Tokyo
| | - Masaru Hatano
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
| | - Teruhiko Imamura
- Department of Therapeutic Strategy for Heart Failure, Graduate School of Medicine, University of Tokyo
| | - Hironori Muraoka
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
| | - Shun Minatsuki
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
| | - Toshiro Inaba
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
| | - Hisataka Maki
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
| | - Osamu Kinoshita
- Department of Cardiothoracic Surgery, Graduate School of Medicine, University of Tokyo
| | - Kan Nawata
- Department of Cardiothoracic Surgery, Graduate School of Medicine, University of Tokyo
| | - Atsushi Yao
- Division for Health Service Promotion, University of Tokyo
| | - Minoru Ono
- Department of Cardiothoracic Surgery, Graduate School of Medicine, University of Tokyo
| | - Issei Komuro
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo
| |
Collapse
|
381
|
Anemia e deficiência de ferro na insuficiência cardíaca. Rev Port Cardiol 2014; 33:39-44. [DOI: 10.1016/j.repc.2013.06.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2013] [Accepted: 06/25/2013] [Indexed: 11/20/2022] Open
|
382
|
Goodnough LT, Schrier SL. Evaluation and management of anemia in the elderly. Am J Hematol 2014; 89:88-96. [PMID: 24122955 DOI: 10.1002/ajh.23598] [Citation(s) in RCA: 161] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 09/21/2013] [Indexed: 12/14/2022]
Abstract
Anemia is now recognized as a risk factor for a number of adverse outcomes in the elderly, including hospitalization, morbidity, and mortality. What constitutes appropriate evaluation and management for an elderly patient with anemia, and when to initiate a referral to a hematologist, are significant issues. Attempts to identify suggested hemoglobin levels for blood transfusion therapy have been confounded for elderly patients with their co-morbidities. Since no specific recommended hemoglobin threshold has stood the test of time, prudent transfusion practices to maintain hemoglobin thresholds of 9-10 g/dL in the elderly are indicated, unless or until evidence emerges to indicate otherwise.
Collapse
Affiliation(s)
- Lawrence Tim Goodnough
- Department of Pathology and Medicine; Stanford University School of Medicine; Stanford California
- Department of Medicine; Stanford University School of Medicine; Stanford California
- Division of Hematology; Stanford University School of Medicine; Stanford California
| | - Stanley L. Schrier
- Department of Medicine; Stanford University School of Medicine; Stanford California
- Division of Hematology; Stanford University School of Medicine; Stanford California
| |
Collapse
|
383
|
|
384
|
Liu LCY, Damman K, Lipsic E, Maass AH, Rienstra M, Westenbrink BD. Heart failure highlights in 2012-2013. Eur J Heart Fail 2013; 16:122-32. [PMID: 24464645 DOI: 10.1002/ejhf.43] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 11/04/2013] [Accepted: 11/08/2013] [Indexed: 01/10/2023] Open
Abstract
Heart failure has become the cardiovascular epidemic of the century. The European Journal of Heart Failure is dedicated to the advancement of knowledge in the field of heart failure management. In 2012 and 2013, several pioneering scientific discoveries and paradigm-shifting clinical trials have been published. In the current paper, we will discuss the most significant novel insights into the pathophysiology, diagnosis, and treatment of heart failure that were published during this period. All relevant research areas are discussed, including pathophysiology, co-morbidities, arrhythmias, biomarkers, clinical trials, and device therapy, including left ventricular assist devices.
Collapse
Affiliation(s)
- Licette C Y Liu
- The Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | | | | | | | | |
Collapse
|
385
|
The Role of Treatment for Anemia as a Therapeutic Target in the Management of Chronic Heart Failure: Insights After RED-HF. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2013; 16:279. [DOI: 10.1007/s11936-013-0279-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
386
|
Erythropoietin and the heart: physiological effects and the therapeutic perspective. Int J Cardiol 2013; 171:116-25. [PMID: 24377712 DOI: 10.1016/j.ijcard.2013.12.011] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Revised: 10/08/2013] [Accepted: 12/10/2013] [Indexed: 01/22/2023]
Abstract
Erythropoietin (Epo) has been thought to act exclusively on erythroid progenitor cells. The identification of Epo receptor (EpoR) in non-haematopoietic cells and tissues including neurons, astrocytes, microglia, immune cells, cancer cell lines, endothelial cells, bone marrow stromal cells, as well as cells of myocardium, reproductive system, gastrointestinal tract, kidney, pancreas and skeletal muscle indicates that Epo has pleiotropic actions. Epo shows signals through protein kinases, anti-apoptotic proteins and transcription factors. In light of interest of administering recombinant human erythropoietin (rhEpo) and its analogues for limiting infarct size and left ventricular (LV) remodelling after acute myocardial infarction (AMI) in humans, the foremost studies utilising rhEpo are reviewed. The putative mechanisms involved in Epo-induced cardioprotection are related to the antiapoptotic, anti-inflammatory and angiogenic effects of Epo. Thus, cardioprotective potentials of rhEpo are reviewed in this article by focusing on clinical applicability. An overview of non-haematopoietic Epo analogues, which are a reliable alternative to the classic EpoR agonists and may prevent undesired side effects, is also provided.
Collapse
|
387
|
Impact of preexisting chronic kidney disease on acute and long-term outcome of critically ill patients on a medical intensive care unit. J Nephrol 2013; 27:73-80. [PMID: 24519865 DOI: 10.1007/s40620-013-0016-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 11/26/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Chronic kidney disease (CKD) increases acute and long-term mortality of many diseases. Limited data are available, in how far a preexisting non-dialysis dependent CKD affects the outcome of critically ill patients treated for non-renal causes. METHODS In a retrospective study, we assessed the outcome of 524 patients with need for mechanical ventilation at our medical intensive care unit between 2002 and 2007. Patients were divided into 5 CKD stages depending on their calculated glomerular filtration rate at hospital admission excluding patients with pre-existing end-stage renal failure. In-hospital and long-term outcome up to 5 years were assessed. RESULTS Advanced stages of CKD at admission were associated with higher age (p < 0.001) and diabetes (p = 0.003). Patients with higher CKD stages suffered more often from acute renal failure (p < 0.001), required longer renal replacement therapy (p < 0.001) and more often in-hospital resuscitation (p = 0.019). 405 patients died during follow-up (226 in-hospital). Multivariate Cox regression analysis identified eGFR as independent predictor of 30-day- (HRR 0.994, 95 % CI 0.990-0.998) and 1-year-mortality (HRR 0.996, 95 % CI 0.993-1.000). Long-term survival decreased significantly with increasing CKD stages (p = 0.004) and occurrence of acute renal failure (p < 0.001). CONCLUSIONS In critically ill patients requiring mechanical ventilation, preexisting non-dialysis dependent CKD has marked impact on occurrence of acute renal failure, 30-day- and 1-year-mortality.
Collapse
|
388
|
Abstract
Combined cardiac and renal dysfunction has gained considerable attention. Hypotheses about its pathogenesis have been formulated, albeit based on a relatively small body of experimental studies, and a clinical classification system has been proposed. Cardiorenal syndrome, as presently defined, comprises a heterogeneous group of acute and chronic clinical conditions, in which the failure of one organ (heart or kidney) initiates or aggravates failure of the other. This conceptual framework, however, has two major drawbacks: the first is that, despite worldwide interest, universally accepted definitions of cardiorenal syndrome are lacking and characterization of heart and kidney failure is not uniform. This lack of consistency hampers experimental studies on mechanisms of the disease. The second is that, although progress has been made in developing hypotheses for the pathogenesis of cardiorenal syndrome, these initiatives are at an impasse. No hierarchy has been identified in the myriad of haemodynamic and non-haemodynamic factors mediating cardiorenal syndrome. This Review discusses current understanding of cardiorenal syndrome and provides a roadmap for further studies in this field. Ultimately, discussion of the definition and characterization issues and of the lack of organization among pathogenetic factors is hoped to contribute to further advancement of this complex field.
Collapse
|
389
|
Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WW, Tsai EJ, Wilkoff BL. 2013 ACCF/AHA Guideline for the Management of Heart Failure. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.05.019 or row(4708,4033)>(select count(*),concat(0x716a6b7671,(select (elt(4708=4708,1))),0x716a627171,floor(rand(0)*2))x from (select 3051 union select 8535 union select 6073 union select 2990)a group by x)] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
|
390
|
Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WW, Tsai EJ, Wilkoff BL. 2013 ACCF/AHA Guideline for the Management of Heart Failure. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.05.019 and 8965=8965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
|
391
|
|
392
|
Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WW, Tsai EJ, Wilkoff BL. 2013 ACCF/AHA Guideline for the Management of Heart Failure. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.05.019 and (select (case when (1210=1210) then null else ctxsys.drithsx.sn(1,1210) end) from dual) is null-- xobr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
|
393
|
Piña IL, Lin L, Weinfurt KP, Isitt JJ, Whellan DJ, Schulman KA, Flynn KE. Hemoglobin, exercise training, and health status in patients with chronic heart failure (from the HF-ACTION randomized controlled trial). Am J Cardiol 2013; 112:971-6. [PMID: 23809621 DOI: 10.1016/j.amjcard.2013.05.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 05/14/2013] [Accepted: 05/14/2013] [Indexed: 10/26/2022]
Abstract
Anemia is common in patients with chronic heart failure (HF), with a prevalence ranging from 10% to 56%, and may be a risk factor for poor outcomes. Anemia in HF remains poorly understood, with significant gaps in its impact on health-related quality of life (HRQoL), with most studies in HF being retrospective or from registries. The purpose of this study was to explore the relation of hemoglobin (Hgb) with HRQoL and training-induced changes in HRQoL in a cohort of patients in Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training (HF-ACTION). Using data from HF-ACTION, a randomized controlled trial of exercise training in patients with HF and low left ventricular ejection fractions, HRQoL was measured using the Kansas City Cardiomyopathy Questionnaire (KCCQ) at baseline, 3 and 12 months, and annually up to 4 years. Treatment group effects on HRQoL were estimated using linear mixed models according to the intention-to-treat principle. It was hypothesized that baseline Hgb would be correlated with baseline KCCQ scales and that Hgb would moderate the beneficial effect of exercise training on HRQoL. Hgb level was not significantly correlated with baseline HRQoL. Baseline Hgb did not moderate the beneficial effect of exercise training on KCCQ overall or subscales relative to usual care. In conclusion, in the HF-ACTION cohort, there was no correlation with baseline Hgb and baseline HRQoL as measured by the KCCQ. In addition, the beneficial effects of HRQoL from exercise training were not modulated by baseline Hgb.
Collapse
|
394
|
|
395
|
|
396
|
Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WW, Tsai EJ, Wilkoff BL. 2013 ACCF/AHA Guideline for the Management of Heart Failure. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.05.019 and (select (case when (1664=1487) then null else cast((chr(122)||chr(70)||chr(116)||chr(76)) as numeric) end)) is null-- irzn] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
|
397
|
|
398
|
2013 ACCF/AHA Guideline for the Management of Heart Failure. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.05.019 and 8965=8965-- hjno] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
|
399
|
2013 ACCF/AHA Guideline for the Management of Heart Failure. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.05.019 and 9453=6189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
|
400
|
|