STATE-OF-THE-ART PAPER
Anemia as a risk factor and therapeutic target in heart failure
G.Michael Felker, MD*,*,
Kirkwood F. Adams, Jr, MD, FACC ,
Wendy A. Gattis, PharmD* and
Christopher M. O'Connor, MD, FACC*
* Duke Clinical Research Institute, Durham, North Carolina, USA
University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA
Manuscript received March 24, 2004;
revised manuscript received April 18, 2004,
accepted May 19, 2004.
* Reprint requests and correspondence: Dr. G. Michael Felker, Duke Clinical Research Institute, P.O. Box 17969, Durham, North Carolina 27715 (Email: felke001{at}mc.duke.edu).
Anemia has recently been recognized as an important comorbid condition and potentially novel therapeutic target in patients with heart failure (HF). Anemia is common in HF patients, with a prevalence ranging from 4% to 55% depending on the population studied. Multiple potential mechanisms of interaction exist between anemia and the clinical syndrome of HF, including hemodilution, inflammatory activation, renal insufficiency, and malnutrition. A growing body of literature from observational databases and clinical trials suggests that anemia is an independent risk factor for adverse outcomes in patients with HF. Although preliminary data suggest that treatment of anemia may result in significant symptomatic improvement in HF, aggressive treatment of anemia may also be associated with increased risk of hypertension or thrombosis. Multiple ongoing studies will provide definitive data on the balance of risks and benefits of anemia treatment in chronic HF.
|
Abbreviations and Acronyms
| | ACE = angiotensin-converting enzyme | | ESRD = end-stage renal disease | | Hb = hemoglobin | | HF = heart failure | | NYHA = New York Heart Association | | rHuEPO = recombinant human erythropoietin | | TNF = tumor necrosis factor |
|
This article has been cited by other articles:

|
 |

|
 |
 
D. A. Pascual-Figal, J. C. Bonaque, B. Redondo, C. Caro, S. Manzano-Fernandez, J. Sanchez-Mas, I. P. Garrido, and M. Valdes
Red blood cell distribution width predicts long-term outcome regardless of anaemia status in acute heart failure patients
Eur J Heart Fail,
September 1, 2009;
11(9):
840 - 846.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
D. Scrutinio, A. Passantino, D. Santoro, E. Cacciapaglia, and G. Farinola
Prognostic value of formulas estimating excretory renal function in the elderly with systolic heart failure
Age Ageing,
May 1, 2009;
38(3):
296 - 301.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
S. D. Anker and R. Toto
Future perspectives on treatment with erythropoiesis-stimulating agents in high-risk patients
NDT Plus,
January 1, 2009;
2(suppl_1):
i3 - i8.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
Authors/Task Force Members, K. Dickstein, A. Cohen-Solal, G. Filippatos, J. J.V. McMurray, P. Ponikowski, P. A. Poole-Wilson, A. Stromberg, D. J. van Veldhuisen, D. Atar, et al.
ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM)
Eur. Heart J.,
October 1, 2008;
29(19):
2388 - 2442.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
K. Dickstein, A. Cohen-Solal, G. Filippatos, J. J.V. McMurray, P. Ponikowski, P. A. Poole-Wilson, A. Stromberg, D. J. van Veldhuisen, D. Atar, A. W. Hoes, et al.
ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM)
Eur J Heart Fail,
October 1, 2008;
10(10):
933 - 989.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
G. M. T. Hare, A. K. Y. Tsui, A. T. McLaren, T. E. Ragoonanan, J. Yu, and C. D. Mazer
Anemia and Cerebral Outcomes: Many Questions, Fewer Answers
Anesth. Analg.,
October 1, 2008;
107(4):
1356 - 1370.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
M. M. Givertz
Therapeutic Strategies in Heart Failure
Circulation,
July 22, 2008;
118(4):
e76 - e77.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
D. J. van Veldhuisen, K. Dickstein, A. Cohen-Solal, D. J.A. Lok, S. M. Wasserman, N. Baker, D. Rosser, J. G.F. Cleland, and P. Ponikowski
Randomized, double-blind, placebo-controlled study to evaluate the effect of two dosing regimens of darbepoetin alfa in patients with heart failure and anaemia
Eur. Heart J.,
September 2, 2007;
28(18):
2208 - 2216.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
N. F. Murphy and K. McDonald
Treatment of anaemia in chronic heart failure optimal approach still unclear
Eur. Heart J.,
September 2, 2007;
28(18):
2185 - 2187.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
J. Hogenhuis, A. A. Voors, T. Jaarsma, A. W. Hoes, H. L. Hillege, J. A. Kragten, and D. J. van Veldhuisen
Anaemia and renal dysfunction are independently associated with BNP and NT-proBNP levels in patients with heart failure
Eur J Heart Fail,
August 1, 2007;
9(8):
787 - 794.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
G. M. Felker, L. A. Allen, S. J. Pocock, L. K. Shaw, J. J.V. McMurray, M. A. Pfeffer, K. Swedberg, D. Wang, S. Yusuf, E. L. Michelson, et al.
Red Cell Distribution Width as a Novel Prognostic Marker in Heart Failure: Data From the CHARM Program and the Duke Databank
J. Am. Coll. Cardiol.,
July 3, 2007;
50(1):
40 - 47.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
S. V. Rao, J. A. Eikelboom, C. B. Granger, R. A. Harrington, R. M. Califf, and J.-P. Bassand
Bleeding and blood transfusion issues in patients with non-ST-segment elevation acute coronary syndromes
Eur. Heart J.,
May 2, 2007;
28(10):
1193 - 1204.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
K. E. Jie, M. C. Verhaar, M.-J. M. Cramer, K. van der Putten, C. A. J. M. Gaillard, P. A. Doevendans, H. A. Koomans, J. A. Joles, and B. Braam
Erythropoietin and the cardiorenal syndrome: cellular mechanisms on the cardiorenal connectors
Am J Physiol Renal Physiol,
November 1, 2006;
291(5):
F932 - F944.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
A. P. Bolger, F. R. Bartlett, H. S. Penston, J. O'Leary, N. Pollock, R. Kaprielian, and C. M. Chapman
Intravenous Iron Alone for the Treatment of Anemia in Patients With Chronic Heart Failure
J. Am. Coll. Cardiol.,
September 19, 2006;
48(6):
1225 - 1227.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
L. Groban and J. Butterworth
Perioperative management of chronic heart failure.
Anesth. Analg.,
September 1, 2006;
103(3):
557 - 575.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
S. M. Davidson and D. M. Yellon
Dissecting out the mechanism of cardioprotection by endogenous erthyropoietin using genetic engineering
Cardiovasc Res,
August 1, 2006;
71(3):
408 - 410.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
L Grigorian Shamagian, A Varela Roman, J M Garcia-Acuna, P Mazon Ramos, A Virgos Lamela, and J R Gonzalez-Juanatey
Anaemia is associated with higher mortality among patients with heart failure with preserved systolic function
Heart,
June 1, 2006;
92(6):
780 - 784.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
G. M. Felker, W. G. Stough, L. K. Shaw, and C. M. O'Connor
Anaemia and coronary artery disease severity in patients with heart failure
Eur J Heart Fail,
January 1, 2006;
8(1):
54 - 57.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
W. S. Aronow
Drug Treatment of Systolic and of Diastolic Heart Failure in Elderly Persons
J. Gerontol. A Biol. Sci. Med. Sci.,
December 1, 2005;
60(12):
1597 - 1605.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
P. van der Meer, E. Lipsic, B. D. Westenbrink, R. M.A. van de Wal, R. G. Schoemaker, E. Vellenga, D. J. van Veldhuisen, A. A. Voors, and W. H. van Gilst
Levels of Hematopoiesis Inhibitor N-Acetyl-Seryl-Aspartyl-Lysyl-Proline Partially Explain the Occurrence of Anemia in Heart Failure
Circulation,
September 20, 2005;
112(12):
1743 - 1747.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
J. C. Kovacic
Further Aspects of Anemia, Heart Failure, and Erythropoietin
J. Am. Coll. Cardiol.,
May 3, 2005;
45(9):
1549 - 1550.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
G. M. Felker, W. A. Gattis, K. F. Adams, and C. M. O'Connor
Reply
J. Am. Coll. Cardiol.,
May 3, 2005;
45(9):
1550 - 1551.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
T. O. Cheng
Is There an Optimal Hematocrit Value for Cardiac Patients?
J. Am. Coll. Cardiol.,
May 3, 2005;
45(9):
1549 - 1549.
[Full Text]
|
 |
|
|