Anemia in Heart Failure Still Relevant?

Niels Grote Beverborg, Dirk J. van Veldhuisen, Peter van der Meer*

*Corresponding author for this work

Research output: Contribution to journalReview articleAcademicpeer-review

35 Citations (Scopus)

Abstract

One-third of all patients with heart failure have anemia, and its presence is associated with more symptoms, increased rates of hospitalization, and increased mortality. The etiology of anemia is multifactorial, complex, and varies between patients. The most important factors leading to anemia in heart failure are inadequate erythropoietin production resulting from renal failure, intrinsic bone marrow defects, medication use, and nutritional deficiencies such as iron deficiency. Erythropoiesis-stimulating agents (ESAs) have been proven to successfully correct hemoglobin levels, albeit without significant improvement in clinical outcome. On the contrary, the use of ESAs has led to increased rates of thromboembolic events and ischemic stroke. This use of ESAs for the treatment of anemia in heart failure, therefore, cannot be recommended. In addition, these results question whether anemia is a therapeutic target or merely a marker of disease severity. Other therapies are being studied and include agents targeting the erythropoietin receptor, hepcidin pathway, or iron availability. This review focuses on the pathophysiology of anemia in heart failure, explains why investigated therapies might not have led to the desired results, and discusses promising future therapies. (c) 2018 by the American College of Cardiology Foundation.

Original languageEnglish
Pages (from-to)201-208
Number of pages8
JournalJACC. Heart failure
Volume6
Issue number3
DOIs
Publication statusPublished - Mar-2018

Keywords

  • anemia
  • erythropoiesis-stimulating agents
  • heart failure
  • iron
  • CANCER-ASSOCIATED ANEMIA
  • CHRONIC KIDNEY-DISEASE
  • IRON-DEFICIENCY
  • FERRIC CARBOXYMALTOSE
  • EXERCISE CAPACITY
  • DARBEPOETIN ALPHA
  • ERYTHROPOIETIN LEVELS
  • RENAL-INSUFFICIENCY
  • AMERICAN-COLLEGE
  • NEW-ONSET

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