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Anemia Is Associated With Blunted Response to β-Blocker Therapy Using Carvedilol - Insights From Japanese Chronic
Yuji Nagatomo1, Tsutomu Yoshikawa1, Hiroshi Okamoto2
1Sakakibara Heart Institute.
Insights
Anemia in heart failure patients receiving carvedilol therapy is linked to a reduced treatment response and worse clinical outcomes. This finding highlights the importance of addressing anemia in heart failure management.
Area of Science:
- Cardiology
- Internal Medicine
- Pharmacology
Background:
- Anemia is associated with poor outcomes in chronic heart failure (CHF).
- The underlying mechanisms linking anemia and CHF outcomes remain unclear.
- This study investigates the impact of anemia on heart failure with reduced ejection fraction (HFrEF) patients treated with carvedilol.
Purpose of the Study:
- To elucidate the effect of anemia on the response to carvedilol therapy in patients with HFrEF.
- To determine if baseline hemoglobin levels predict treatment response and clinical outcomes.
- To assess the influence of anemia on left ventricular ejection fraction (LVEF) and B-type natriuretic peptide (BNP) levels.
Main Methods:
- Prospective, randomized, multicenter J-CHF study involving 360 HFrEF patients.
- Patients were assigned to carvedilol treatment groups based on target dosage.
- Anemia was defined as hemoglobin <13 g/dL (men) or <12 g/dL (women).
Main Results:
- Anemia was present in 19% of patients at baseline.
- Anemic patients showed a smaller improvement in LVEF and BNP levels compared to non-anemic patients.
- Baseline hemoglobin was an independent predictor of LVEF change and BNP levels.
- Anemia was associated with a higher incidence of death and cardiovascular hospitalizations.
- Chronic kidney disease did not influence the response to carvedilol therapy.
Conclusions:
- Anemia is associated with a blunted response to carvedilol in HFrEF patients.
- Baseline hemoglobin levels are crucial for predicting treatment efficacy and prognosis in HFrEF.
- Addressing anemia may be important for improving outcomes in HFrEF patients treated with carvedilol.
Background:
Anemia portends a poor clinical outcome in patients with chronic heart failure (CHF). However, its mechanism remains unknown. We sought to elucidate the effect of anemia on patients with HF with reduced ejection fraction (HFrEF) who receive carvedilol therapy.
Methods And Results:
J-CHF study was a prospective, randomized, multicenter trial that assigned 360 HFrEF patients to 2.5 mg/5 mg/20 mg carvedilol groups according to the target dose. At baseline 70 patients (19%) had anemia ([A]) defined as hemoglobin level (Hb) <13 g/dL (male) or <12 g/dL (female) and the remaining 290 did not ([N]). Allocated and achieved doses of carvedilol were similar. Left ventricular ejection fraction (LVEF) and plasma B-type natriuretic peptide (BNP) level significantly improved in both groups over 56 weeks, but they were smaller in [A] than in [N] (LVEF, P=0.046; BNP, P<0.0001 by ANOVA). Baseline Hb was an independent predictor of absolute change in LVEF (β=0.13, P=0.047) and BNP (β=-0.10, P=0.01). Presence of chronic kidney disease defined as estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2at baseline was not associated with differential response to carvedilol therapy. During 3.8±1.4 years follow-up, group [A] had a higher incidence of the composite endpoint of death, hospitalization for cardiovascular causes including HF compared with [N] (P=0.006). Baseline Hb was an independent predictor of the composite endpoint (hazard ratio 0.86, P=0.04), whereas baseline eGFR was not.
Conclusions:
Our data suggested that anemia was associated with a blunted response to carvedilol in HFrEF patients.
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