Excerpt

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.

Contents

• PREFACE
• EXECUTIVE SUMMARY
  • BACKGROUND
  • METHODS
  • RESULTS
  • DISCUSSION/CONCLUSION
  • EXECUTIVE SUMMARY TABLE
• INTRODUCTION
• METHODS
  • TOPIC DEVELOPMENT
  • SEARCH STRATEGY
  • STUDY SELECTION
  • DATA ABSTRACTION
  • STUDY QUALITY
  • RATING THE BODY OF EVIDENCE
  • DATA SYNTHESIS
  • PEER REVIEW
• RESULTS
  • LITERATURE FLOW
  • KEY QUESTION #1 In patients with CHF or CHD, what are the health outcome benefits and harms of treating anemia with ESAs?
  • KEY QUESTION #2 In patients with CHF or CHD, what are the health outcome benefits and harms of using iron to treat iron deficiency with or without anemia?
  • KEY QUESTION #3 In patients with CHF or CHD, what are the health outcome benefits and harms of treating anemia with red blood cell transfusions?
• SUMMARY AND DISCUSSION
  • CLINICAL APPLICATIONS
  • LIMITATIONS
  • FUTURE STUDIES
  • CONCLUSIONS
• REFERENCES
• APPENDIX A SEARCH STRATEGY
• APPENDIX B INCLUSION/EXCLUSION CRITERIA
• APPENDIX C QUALITY ASSESSMENT TABLES
• APPENDIX D PEER REVIEW COMMENTS AND RESPONSES

Prepared for: Department of Veterans Affairs, Veterans Health Administration, Health Services Research & Development Service, Washington, DC 20420. Prepared by: Evidence-based Synthesis Program (ESP) Center, Portland VA Medical Center, Portland, OR, Devan Kansagara, M.D., M.C.R., Director

Suggested citation:

Kansagara D, Dyer EAW, Englander H, Freeman M, Kagen D, Treatment of Anemia in Patients with Heart Disease: A Systematic Review. VA-ESP Project #05- 225; 2011.

This report is based on research conducted by the Evidence-based Synthesis Program (ESP) Center located at the Portland VA Medical Center, Portland OR funded by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Health Services Research and Development. The findings and conclusions in this document are those of the author(s) who are responsible for its contents; the findings and conclusions do not necessarily represent the views of the Department of Veterans Affairs or the United States government. Therefore, no statement in this article should be construed as an official position of the Department of Veterans Affairs. No investigators have any affiliations or financial involvement (e.g., employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties) that conflict with material presented in the report.