Tag Archives: anaemia

Anaemia in chronic heart failure: what constitutes optimal investigation and treatment? Dear Sirs, We read with interest the recent supplement on anaemia in heart failure patients.1 Since the publication by Bolger et al.2 on the benefits of intravenous iron therapy in chronic heart failure (CHF), we have been screening for anaemia and iron deficiency in this cohort. We actively treat these patients based on the criteria of a haemoglobin level less than 12 g/dL, already on optimal conventional heart failure therapy, New York Heart Association (NYHA) class II symptoms or worse, and a ferritin of less than 100 μg/L. We were previously using an

Correction of anaemia is, therefore, an appealing strategy. Whilst erythropoietin levels may be elevated in CHF, they are often lower than expected when considering the haemoglobin concentration, indicating a relative deficiency. Similarly, iron metabolism is frequently disturbed, with many patients experiencing either an absolute or functional deficiency. Chronic iron deficiency may contribute to breathlessness and reduced exercise capacity, the hallmarks of symptomatic CHF. This supplement aims to increase awareness of anaemia in CHF and also to provide an overview of recent studies of erythropoiesis-stimulating agents (ESAs) and of intrav

SAPIEN valve positive results Clinicians have achieved successful one-year outcomes in high-risk or inoperable patients undergoing transcatheter aortic valve replacement during the first two years since release of the valve (Sapien®, Edwards) commercially, according to results presented at the Euro PCR 2001 meeting in Paris, France. Despite high predicted mortality and multiple co-morbidities in many of these patients, survival at one year was 76% in the 1,038 patients treated as part of Cohort I (first year of commercialisation), and 77% in the 1,269 patients treated as part of Cohort II (second year of commercialisation).  Since November

Prevalence In published reports of patients with heart failure, the prevalence of anaemia varies markedly, reflecting the very varied characteristics of the studied populations. In reports based upon clinical trials, the reported prevalence ranges from 10–25% (figure 1), while in cohorts of patients in observational or registry-based studies, it appears to be higher, from 15–50% (figure 2). This variation is unsurprising given the relatively selected nature of patients recruited to clinical trials in CHF. A reasonable overall estimate can be gleaned from a large systematic review of 34 studies, including more than 150,000 patients, in wh

Table 1. Origins of anaemia Haematinic deficiency The commonest single haematinic deficiency related to anaemia in patients with CHF is iron deficiency. Around half of all patients with anaemia have evidence of iron deficiency on the basis of abnormal results for serum iron, iron binding capacity and ferritin.1,2 Folate or vitamin B12 deficiency is relatively uncommon. Iron is used by the body not only for haemoglobin production but in a variety of enzyme systems, which may be affected by iron deficiency. There are many possible reasons for iron deficiency in patients with CHF. Dietary intake may be poor in the elderly population, and blood l

The situation in the anaemia of CHF is less advanced, but in recent years there has been increasing interest in the use of both of these treatment strategies. A few small clinical trials have suggested some potential benefits of stimulating erythropoiesis with ESA therapy in heart failure anaemia, whilst the administration of IV iron has shown similar benefits even in the absence of ESA therapy. Indeed, the recently published FAIR-HF (Ferinject® Assessment in patients with Iron deficiency and chronic Heart Failure) trial1 has opened the eyes of cardiologists to the potential for this latter treatment strategy to improve the symptoms and sig

Epidemiology of anaemia in CKD The likelihood of anaemia occurring in CKD increases as renal function declines. All patients receiving haemodialysis therapy will require treatment for anaemia, and so too will almost all of those receiving peritoneal dialysis (the difference accounted for by haemodialysis exposing the patient to a greater inflammatory state, and also regular minor blood losses). Below a glomerular filtration rate (GFR) of 45 ml/min, erythropoietin secretion by the kidney declines and when patients enter stage 4 CKD (eGFR < 30 ml/min), around 30–40% will be anaemic. Aetiology of anaemia in CKD Figure 1. Factors contributi

Neurohormonal blockade A cardiac resynchronisation therapy pacemaker (CRT-P), provides cardiac resynchronisation therapy and diagnostics to assist in patient management The meeting set off to a stimulating start with Professor Theresa McDonagh (Kings College Hospital, Chair of the British Society of Heart Failure) reviewing primarily the growing evidence for aldosterone antagonists in the management of systolic heart failure (HF). Large clinical trials have established the role of aldosterone antagonists, such as spironolactone, in severe systolic HF (Randomised Aldactone Evaluation Study – RALES) and eplerenone in acute myocardial infarcti

Report shows access to cardiac care is patchy in the UK A new UK-wide study, mapping disparities in access to cardiac care, has “major implications for provision of services throughout the UK” says Professor Keith Fox (University of Edinburgh) President, British Cardiovascular Society (BCS). The report, commissioned by the BCS, the British Heart Foundation and the Cardio & Vascular Coalition, shows that despite finding a marked increase in provision of the main cardiac treatments in the country, there were many parts of the UK where access was significantly below the levels expected. It also shows the UK being in the lower quartile fo