Treatment of anemia in patients with heart disease: a systematic review

Area of Science:

• Cardiology
• Hematology

Background:

• Anemia treatment benefits in heart disease patients remain uncertain.
• U.S. Department of Veterans Affairs funded this research.

Purpose of the Study:

• To evaluate the benefits and harms of anemia treatments in adults with heart disease.
• Assessed blood transfusions, iron, and erythropoiesis-stimulating agents.

Main Methods:

• Searched MEDLINE, EMBASE, Cochrane databases, and clinical trial registries.
• Included English-language trials and observational studies on anemia in heart failure or coronary heart disease.
• Extracted data on study design, population, hemoglobin, and outcomes; assessed trial quality.

Main Results:

• Liberal blood transfusion protocols did not improve short-term mortality compared to less aggressive ones (RR, 0.94; 95% CI, 0.61 to 1.42).
• Intravenous iron improved short-term exercise tolerance and quality of life in heart failure patients.
• Erythropoiesis-stimulating agents showed no consistent benefits and may increase risks like venous thromboembolism.

Conclusions:

• Higher transfusion thresholds do not consistently improve mortality; large trials are needed.
• Intravenous iron may alleviate symptoms in heart failure patients with iron deficiency, warranting further study.
• Erythropoiesis-stimulating agents appear ineffective for mild to moderate anemia in heart disease and carry risks.