Do erythropoiesis-stimulating agents help adults with heart failure and anaemia?
Erythropoiesis-stimulating agents (ESAs) are drugs that boost red blood cell production. In adults with heart failure and anaemia, ESAs can help raise hemoglobin levels and improve exercise capacity. However, their effect on hospitalizations and survival is mixed. A large meta-analysis found that ESAs reduce the total number of heart failure hospitalizations but do not lower the risk of a first hospitalization or death 15.
What the research says
A systematic review and meta-analysis of 14 randomized trials involving 3,128 adults with chronic heart failure and anaemia provides the best evidence 15. The analysis showed that ESAs significantly reduced the total number of heart failure hospitalizations: 622 events per 2,698 person-years with ESAs versus 761 per 2,914 person-years with control (incidence rate ratio 0.81) 15. However, there was no significant difference in the risk of a first heart failure hospitalization (odds ratio 0.93) or all-cause mortality (odds ratio 1.01) 15. Patients taking ESAs increased their hemoglobin by an average of 1.6 g/dL and improved their exercise tolerance by 69 meters on a six-minute walk test 15. The quality of evidence was moderate, and adverse events were similar between groups 15. Another study estimated that treating anaemia in older heart failure patients with ESAs and intravenous iron would cost about £2.7 million per year for a health district of 424,654 people 6.
What to ask your doctor
- Could ESAs help improve my energy and exercise ability?
- What are the possible side effects of ESAs for someone with heart failure?
- How would my hemoglobin levels be monitored if I start ESAs?
- Are there other treatments for anaemia in heart failure, such as iron supplements?
- Would ESAs reduce my risk of being hospitalized for heart failure?
This question is drawn from common patient questions about Cardiology and answered using cited medical research. We do not provide individualized advice.