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Treatment of Anemia in Patients with Heart Disease

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Treatment of Anemia in Patients with Heart Disease (October 2011)

Principal Investigator: Devan Kansagara, M.D., M.C.R.
Co-Investigators: Edward Dyer, M.D.; Honora Englander, M.D.; David Kagen, M.D.

Evidence-based Synthesis Program (ESP) Center
Portland VA Medical Center

Washington (DC): Department of Veterans Affairs; October 2011

Download PDF: Complete Report, Executive Summary, Report, Appendices

Background

Anemia is very common in congestive heart failure (CHF) and coronary heart disease (CHD) patients. Anemia in CHF and CHD patients is associated with poorer outcomes, including an increased risk of hospitalization, decreased exercise capacity, and poor quality of life. Despite the association with poorer outcomes, it is unclear whether treating anemia or iron deficiency will improve outcomes. Anemia treatment strategies in heart failure and CHD patients include erythropoiesis-stimulating agents (ESAs) and red blood cell transfusions. Iron replacement in iron deficient patients with or without anemia has also been investigated. The objective of this evidence review is to evaluate the balance of benefit and harms of these treatments.

We conducted a systematic review to address the following key questions:

In patients with CHF or CHD,

Key Question #1: What are the health outcome benefits and harms of treating anemia with ESAs? Key Question #2: What are the health outcome benefits and harms of using iron to treat iron deficiency with or without anemia? Key Question #3: What are the health outcome benefits and harms of treating anemia with red blood cell transfusions?

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