Congestive heart failure: severe, refractory: correcting anaemia with erythropoietin and iron reduced time in hospital

Clinical bottom line (level 1b)

  1. Patients with severe refractory congestive heart failure and anaemia who received erythropoietin and iron compared with no treatment required less iv frusemide (roughly 60 mg less a week), had higher ejection fractions (on average 13% higher) and spent less time in hospital (on average by 13 days) after 6 months.
Silverberg et al: J Am Coll Cardiol 2001; 37 : 1775-1780
Expires May 2004

The study

Unblinded unconcealed randomised trial with intention-to-treat
Setting: cardiology clinic, Israel

32 patients (aged mean 73, 72% male) with severe resistant congestive heart failure (on maximally-tolerated doses of ACE inhibitors, beta-blockers, aldospirone, long-acting nitrates, digoxin and furosemide for at least 6 months and still in NYHA class III or IV) and anaemia (Hb 10 - 11.5 g/dl)

Excluded if
  • ejection fraction > 40%
  • other cause for anaemia: hypothyroidism, vitamin B-12 or folate deficiency

Control Group: (n = 16, 16 analysed): no treatment
Experimental Group: (n = 16, 16 analysed): erythropoietin 4000 units sc per week initially and adjusted to maintain Hb 12.5 g/dl; and ferric sucrose 200 mg iv in 150 ml saline over 60 min every 2 weeks until serum ferritin > 400 microg/l or %Fe saturation 40% or Hb 12.5 g/dl.

100% followed for 5-12 months

The evidence

Outcome Control Group
(SD)		 Experimental Group
(SD)		 Mean Difference
(95% CI)
iv frusemide mg per week 63.1
(37.1) 		6.6
(28.2) 		-57
(-80 to 33)
days in hospital 15.6
(9.8) 		2.9
(6.6) 		-13
(-19 to -6.7)
ejection fraction 23.0
(6.9) 		36.3
(11.9) 		13
(6.3 to 20)

Comments

  1. The lack of blinding in the study and the small numbers involved means that these results should be treated with caution.

Citation

  1. Silverberg DS, Wexler Dov, Sheps D, et al: the effect of correction of mild anemia in severe, resistant congestive heart failure using subcutaneous erythropoeitin and intravenous iron: a randomized controlled study. J Am Coll Cardiol 2001; 37 : 1775-1780
Search Terms: from ACP Journal Club other articles noted
Contributor: Chris Ball, May 2002
Reviewer:

Clinical Question.
Patient severe congestive heart failure and anaemia
Intervention or Exposure erythropoeitin and iron
Comparison no treatment
Outcome time in hospital , ejection fraction