The effect of correction of mild anemia in severe, resistant congestive heart failure using subcutaneous erythropoietin and intravenous iron: A randomized controlled study

OBJECTIVES This is a randomized controlled study of anemic patients with se vere congestive heart failure (CHF) to assess the effect of correction of t he anemia on cardiac and renal function and hospitalization. BACKGROUND Although mild anemia occurs frequently in patients with CHF, the re is very little information about the effect of correcting it with erythr opoietin (EPO) and intravenous iron. METHODS Thirty-two patients with moderate to severe CHF (New York Heart Ass ociation [NYHA] class III to IV) who had a left ventricular ejection fracti on (LVEF) of less than or equal to 40% despite maximally tolerated doses of CHF medications and whose hemoglobin (Hb) levels were persistently between 10.0 and 11.5 g% were randomized into two groups. Group A (16 patients) re ceived subcutaneous EPO and IV iron to increase the level of Hb to at least 12.5 g%. In Group B (16 patients) the anemia was not treated. The doses of all the CHF medications were maintained at the maximally tolerated levels except for oral and intravenous (IV) furosemide, whose doses were increased or decreased according to the clinical need. RESULTS Over a mean of 8.2 +/- 2.6 months, four patients in Group B and non e in Group A died of CHF-related illnesses. The mean NYHA class improved by 42.1% in A and worsened by 11.4% in B. The LVEF increased by 5.5% in A and decreased by 5.4% in B. The serum creatinine did not change in A and incre ased by 28.6% in B. The need for oral and IV furosemide decreased by 51.3% and 91.3% respectively in A and increased by 28.5% and 28.0% respectively i n B. The number of days spent in hospital compared with the same period of time before entering the study decreased by 79.0% in A and increased by 57. 6% in B. CONCLUSIONS When anemia in CHF is treated with EPO and IV iron, a marked im provement in cardiac and patient function is seen, associated with less hos pitalization and renal impairment and less need for diuretics. (J Am Coll C ardiol 2001;37:1775-80) (C) 2001 by the American College of Cardiology.