A meta-analysis of erythropoiesis-stimulating agents in anaemic patients with chronic heart failure

Anaemia is a frequent comorbidity in patients with chronic heart failure (CHF) and is associated with worse outcomes. It is logical to consider whether correcting anaemia is a novel therapeutic target in such patients. We performed a meta-analysis to explore whether treatment of anaemia with erythropoietin-stimulating agents (ESA) can improve symptoms and progression in patients with CHF.

Studies were identified in English-language articles by searching PUBMED (inception to May 2009). A standardized protocol with predefined criteria was used to extract details on study design, Jadad score, demographic data, interventions, and outcomes. The main outcome measures were cardiac function, exercise capacity, quality of life, and all-cause mortality. Seven randomized controlled trials involving 678 patients were identified and included in the analysis. Cardiac function as well as exercise capacity were improved post-treatment in the ESA group; however, the overall deaths analysis demonstrated a lower trend but no significant protective effect in the ESA treatment group (RR, 0.71; 95% confidence interval, 0.41-1.24; P = 0.23).

This meta-analysis suggests a symptomatic improvement in anaemic patients with CHF receiving ESA. However, a non-significant reduction in all-cause mortality in the ESA treatment group compared with the control group was observed.