RESUMO
Anemia has been identified as an independent prognostic factor of both morbidity and mortality for patients with congestive heart failure (CHF). The association between anemia and adverse outcomes has raised the hypothesis that anemia correction might lead to an improvement in the prognosis of patients with CHF. Nevertheless, data from large randomized trials about the effect of anemia correction on patient outcome are still lacking. Numerous clinical studies, randomized and nonrandomized, have evaluated the efficacy of erythropoietin or iron supplementation for treating anemia in patients with CHF, and their effect on patient symptoms and functional status. The superiority of any of these approaches has not been established yet. This review will discuss different treatment options for anemic patients with CHF, with emphasis on the correction of iron deficiency.
Assuntos
Anemia Ferropriva/tratamento farmacológico , Suplementos Nutricionais , Eritropoetina/uso terapêutico , Cardiopatias/complicações , Ferro da Dieta/uso terapêutico , Anemia Ferropriva/complicações , Anemia Ferropriva/prevenção & controle , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de RiscoRESUMO
Anemia has been recognized as a very common and serious comorbidity in heart failure, with a prevalence ranging from 10 to 79%, depending on diagnostic definition, disease severity and patient characteristics. A clear association of anemia with worse prognosis has been confirmed in multiple heart failure trials. This finding has recently triggered intense scrutiny in order to identify the underlying pathophysiology and the best treatment options. Etiology is multifactorial, with iron deficiency and cytokine activation (anemia of chronic disease) playing the most important roles. Treatment is aimed at not only restoring hemoglobin values back to normal, but also at improving the patient's symptoms, functional capacity and hopefully the outcome. Iron supplementation and erythropoietin-stimulating agents have been used for this purpose, either alone or in combination. In this review, the recent advances in elucidating the mechanisms leading to anemia in the setting of heart failure are presented and the evidence supporting the use of different treatment approaches are discussed.
Assuntos
Anemia/fisiopatologia , Insuficiência Cardíaca/epidemiologia , Anemia/epidemiologia , Anemia/etiologia , Anemia/terapia , Anemia Ferropriva , Antagonistas de Receptores de Angiotensina , Inibidores da Enzima Conversora de Angiotensina , Comorbidade , Citocinas/metabolismo , Eritropoetina/biossíntese , Hemodiluição , Humanos , Nefropatias , Prevalência , PrognósticoRESUMO
Anemia is frequently observed in patients with chronic heart failure and is increasingly recognized as an important and treatable condition. The present review will summarize the current knowledge of the prevalence, causative factors, and pathophysiologic correlates of anemia in chronic heart failure. Despite increasing knowledge of anemia there are very few evidence-based recommendations for treatment. Potential benefits of therapy with supplemental hematinics such as iron, subcutaneous erythropoiesis-stimulating agents, or both will also be discussed.