Correcting Anemia in Heart Failure: The Efficacy and Safety of Erythropoiesis-Stimulating Agents

BackgroundRandomized controlled trials (RCTs) evaluating the efficacy and safety of erythropoiesis-stimulating agents (ESAs), including erythropoietin and darbepoetin, among patients with chronic heart failure (CHF) and anemia have yielded heterogeneous results, and important safety questions remain unanswered. We therefore undertook a meta-analysis to examine the effects of ESAs in this population.Methods and ResultsWe systematically searched EMBASE, Medline, the Cochrane Library, ClinicalTrials.gov, and relevant bibliographies to identify all relevant RCTs. Data were aggregated using random-effects models. We identified 9 RCTs (n = 747 patients). Compared with control, ESAs were associated with a significant reduction in CHF-related hospitalizations (odds ratio [OR] = 0.41; 95% confidence interval [CI] = 0.24-0.69). The effect of ESAs on mortality was inconclusive (OR = 0.60; 95% CI = 0.32-1.11). ESAs were associated with improved quality of life and left ventricular ejection fraction, lower brain-natriuretic peptide levels, and improved exercise tolerance test performance. There was no evidence of an increase in the incidence of adverse events among patients randomized to ESAs (OR = 0.86; 95% CI = 0.51-1.42).ConclusionsIn patients with CHF and anemia, ESAs are associated with a decrease in CHF-related hospitalizations 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.