The use of subcutaneous erythropoietin and intravenous iron for the treatment of the anemia of severe, resistant congestive heart failure improves cardiac and renal function and functional cardiac class, and markedly reduceshospitalizations

OBJECTIVES This study evaluated the prevalence and severity of anemia in pa tients with congestive heart failure (CHF) and the effect of its correction on cardiac and renal function and hospitalization. BACKGROUND The prevalence and significance of mild anemia in patients with CHF is uncertain, and the role of erythropoietin with intravenous iron supp lementation in treating this anemia is unknown. METHODS In a retrospective study, the records of the 142 patients in our CH F clinic were reviewed to find the prevalence and severity of anemia (hemog lobin [Hb] <12 g). In an intervention study, 26 of these patients, despite maximally tolerated therapy of CHF for at least six months, still had had s evere CHF and were also anemic. They were treated with subcutaneous erythro poietin and intravenous iron sufficient to increase the Hb to 12 g%. The do ses of the CHF medications, except for diuretics, were not changed during t he intervention period. RESULTS The prevalence of anemia in the 142 patients increased with the sev erity of CHF, reaching 79.1% in those with New York Heart Association class IV. In the intervention study, the anemia of the 26 patients was treated f or a mean of 7.2 +/- 5.5 months. The mean Hb level and mean left ventricula r ejection fraction increased significantly. The mean number of hospitaliza tions fell by 91.9% compared with a similar period before the study. The Ne w York Heart Association class fell significantly, as did the doses of oral and intravenous furosemide. The rate of fall of the glomerular filtration rate slowed with the treatment. CONCLUSIONS Anemia is very common in CHF and its successful treatment is as sociated with a significant improvement in cardiac function, functional cla ss, renal function and in a marked fall in the need for diuretics and hospi talization. (J Am Coll Cardiol 2000;35:1737-44) (C) 2000 by the American Co llege of Cardiology.