Mohammad Hafizullah.
Recent advances in management of anemia in heart failure.
Pak Heart J Jan ;50(4):199-204.

Though treatment and outcomes have significantly improved over the past 15 years, morbidity and mortality of heart failure (HF) remains very high. In the setting of heart failure co-morbidities such as iron deficiency is present in nearly 50% and anemia in 37%. Prevalence of anemia in heart failure depending on the definitions used, varies from 15% to 56%. In a retrospective study of outpatients with CHF, the prevalence of anemia, using the World Health Organization (WHO)definition (hemoglobin<12 g/dL in women and<13 g/dL in men), ranged from 9% to 19% in NYHA class I to II, to 79% in NYHA class IV. Anemia has convincingly been shown to be a powerful predictor of re-hospitalization rates and survival in chronic heart failure. Most studies have shown a linear relationship between hematocrit or haemoglobin and survival. SOLVD (Studies of Left Ventricular Dysfunction) trial reported 2.7% increase in the adjusted risk of death per 1% reduction in hematocrit and PRAISE (Prospective Randomized Amlodipine Survival Evaluation) trial described 3% increase in risk for each 1% decline in hematocrit. In a study on significance of anemia among patients hospitalized with acute decompensated heart failure OPTIME-CHF (Outcomes of a Prospective Trial of Intravenous Milrinone for Exacerbations of Chronic Heart Failure) documented that hemoglobin level independently predicted adverse events, even after adjustment for other covariates. For every 1 g/dl decrease in haemoglobin value, a 12% increase in the probability of death or re-hospitalization within 60 days of treatment was observed. In patients of heart failure with preserved systolic function, anemia was found to be independently associated with \adverse outcomes (adjusted hazard ratio: 1.6 to 1). To conclude, anemia in patients with HF is present in approximately one-third of patients with HF, and these patients have a orse prognosis and poor quality of life. The problem may be far more worse in our scenario. Anemia has multifactorial causes and may be due to nutritional deficiencies, renal disease, and volume overload. Although it is recommended that underlying disorders should be addressed, there is no evidence for the clinical benefit of increasing Hb levels as such.Intravenous iron treatment in HF appears promising for iron-deficiency and anemia. The benefit is partly independent of Hb levels, and data on hard clinical endpoints are not yet available. As per to date, ESA therapy has shown neutral results on rates of death and HF re-hospitalization and causes more ischemic strokes, which outweigh their marginal effect on symptom improvement.

PakMediNet -Pakistan's largest Database of Pakistani Medical Journals - http://www.pakmedinet.com