Abstract 3023: Correcting Anemia in Heart Failure: A Meta-Analysis of the Efficacy and Safety of Erythropoiesis-Stimulating Agents
Background- Randomized controlled trials (RCTs) evaluating the efficacy and safety of erythropoiesis-stimulating agents (ESAs) among patients with congestive heart failure (CHF) and anemia have yielded heterogeneous results. We therefore undertook a meta-analysis of the available RCTs to examine the effects of ESAs in this population.
Methods and Results- We systematically searched EMBASE, Medline, the Cochrane Library, ClinicalTrials. gov, and relevant bibliographies to identify all RCTs examining the effect of ESAs among anemic CHF patients. We restricted our search to those published in English with follow-up ≥3 months. Data were aggregated using random-effects models. We identified 8 RCTs involving a total of 689 patients. Three studies examined the use of recombinant erythropoietin and 5 used an analog, darbepoetin-α. All RCTs enrolled patients with hemoglobin levels in the range of 9.0 to 12.5 g/dL. Follow-up ranged from 3 to 12 months, with 4 RCTs having ≥6 months of follow-up. Compared with placebo, use of ESAs was associated with a reduction in CHF-related hospitalizations (odds ratio [OR]=0.42; 95% confidence interval (CI)=0.23, 0.77) and fewer CHF exacerbations overall (OR=0.43; 95% CI=0.21, 0.92). The effect of ESAs on mortality was inconclusive (OR=0.59; 95% CI=0.31, 1.14). ESAs were associated with improved quality of life (mean difference in Minnesota Living with Heart Failure Questionnaire scores=−2.29; 95% CI=−2.64, −1.95). Patients randomized to ESA had improved LVEF (range: +5% to 6%) whereas those randomized to placebo did not (range: −5% to 1%) in the 3 RCTs that examined this outcome. ESAs were also associated with a greater improvement in performance on 6-minute walk tests (4 RCTs, range: +34 m to 73 m) compared with placebo (range: −47 m to 37 m). There was no evidence of an increase in the incidence adverse events among patients randomized to ESAs (OR=0.85; 95% CI=0.53, 1.36).
Conclusions- In patients with CHF and anemia, ESAs are associated with a substantial decrease in CHF-related hospitalizations and CHF exacerbations, and improved quality of life and exercise tolerance. However, RCTs completed to date have involved a small number of patients, and available mortality data are inconclusive.