Erythropoietin Treatment in Patients with Chronic Heart Failure: a meta-analysis.

BACKGROUND: Anemia is common in patients with chronic heart failure (HF) and is related to an increased mortality risk. Erythropoiesis Stimulating Proteins (ESP) are frequently used for the treatment of anemia. However, recent studies in patients with malignancies and renal failure raised concerns about the safety of these agents. AIM: Whether treatment of anemic chronic HF patients with ESPs is associated with an effect on morbidity and mortality. METHODS: A systematic literature search in MEDLINE, the Cochrane Controlled Clinical Trials Register Database and ClinicalTrials.gov through July 2008 was performed. We included randomized clinical trials comparing the effect of ESP treatment with placebo or usual care. RESULTS: We identified seven randomized controlled trials that enrolled 650 patients of which 363 were treated with ESPs and 287 with placebo. ESP treatment had a significantly lower risk of HF hospitalisation (RR 0.59, [95%CI 0.41-0.86];p=0.006).There was no significant difference in the mortality risk between the two groups (RR 0.69, [95%CI 0.39-1.23];p=0.21). No significant differences were observed in the occurrence of hypertension or venous thrombosis. CONCLUSIONS: In chronic HF, treatment with ESPs is not associated with a higher mortality rate or more adverse events, whereas a beneficial effect on HF hospitalisation is seen. These outcomes are in contrast with studies in cancer and kidney disease, and support a large phase III morbidity and mortality trial of anemia correction in CHF patients.