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J Am Coll Cardiol, 2000; 35:1737-1744
© 2000 by the American College of Cardiology Foundation
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CLINICAL STUDIES

The use of subcutaneous erythropoietin and intravenous iron for the treatment of the anemia of severe, resistant congestive heart failure improves cardiac and renal function and functional cardiac class, and markedly reduces hospitalizations

Donald S. Silverberg, MDa, Dov Wexler, MDa, Miriam Blum, MDa, Gad Keren, MDa, David Sheps, MDa, Eyal Leibovitch, MDa, David Brosh, MDa, Shlomo Laniado, MDa, Doron Schwartz, MDa, Tatyana Yachnin, MDa, Itzhak Shapira, MDa, Dov Gavish, MDa, Ron Baruch, MDa, Bella Koifman, MDa, Carl Kaplan, MDa, Shoshana Steinbruch, RNa and Adrian Iaina, MDa

a Department of Nephrology and Cardiology, and Congestive Heart Failure Program, Tel Aviv Medical Center, Tel Aviv, Israel

Manuscript received July 9, 1999; revised manuscript received December 10, 1999, accepted February 3, 2000.

Reprint requests and correspondence: Dr. D. S. Silverberg, Department of Nephrology, Tel Aviv Medical Center, Weizman 6, Tel Aviv, 64239, Israel

OBJECTIVES

This study evaluated the prevalence and severity of anemia in patients with congestive heart failure (CHF) and the effect of its correction on cardiac and renal function and hospitalization.

BACKGROUND

The prevalence and significance of mild anemia in patients with CHF is uncertain, and the role of erythropoietin with intravenous iron supplementation in treating this anemia is unknown.

METHODS

In a retrospective study, the records of the 142 patients in our CHF clinic were reviewed to find the prevalence and severity of anemia (hemoglobin [Hb] <12 g). In an intervention study, 26 of these patients, despite maximally tolerated therapy of CHF for at least six months, still had had severe CHF and were also anemic. They were treated with subcutaneous erythropoietin and intravenous iron sufficient to increase the Hb to 12 g%. The doses of the CHF medications, except for diuretics, were not changed during the intervention period.

RESULTS

The prevalence of anemia in the 142 patients increased with the severity of CHF, reaching 79.1% in those with New York Heart Association class IV. In the intervention study, the anemia of the 26 patients was treated for a mean of 7.2 ± 5.5 months. The mean Hb level and mean left ventricular ejection fraction increased significantly. The mean number of hospitalizations fell by 91.9% compared with a similar period before the study. The New York Heart Association class fell significantly, as did the doses of oral and intravenous furosemide. The rate of fall of the glomerular filtration rate slowed with the treatment.

CONCLUSIONS

Anemia is very common in CHF and its successful treatment is associated with a significant improvement in cardiac function, functional class, renal function and in a marked fall in the need for diuretics and hospitalization.

Abbreviations and Acronyms
  ACE = angiotensin-converting enzyme
  CHF = congestive heart failure
  COPD = chronic obstructive pulmonary disease
  CRF = chronic renal failure
  CVA = cerebrovascular accident
  EPO = erythropoietin
  Fe = iron
  g% = grams Hb per 100 ml blood
  GFR = glomerular filtration rate
  Hb = hemoglobin
  Hct = hematocrit
  IV = intravenous
  LVEF = left ventricular ejection fraction
  LVH = left ventricular hypertrophy
  NYHA = New York Heart Association
  %Fe Sat = percent iron saturation
  SC = subcutaneous
  TNF = tumor necrosis factor




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