ACP recommends tighter transfusion strategy to treat anemia in patients with heart disease

December 2, 2013

Red blood cell (RBC) transfusions should be restricted to those individuals with severe anemia in patients with heart disease, the American College of Physicians (ACP) recommends in a new clinical practice guideline published today in Annals of Internal Medicine, ACP's flagship journal.

ACP also recommends against using erythropoiesis-stimulating agents (ESAs) in with mild to moderate anemia and congestive heart failure (CHF) or (CHD) because the harms, including increased risks of thromboembolic events and stroke rates, outweigh the benefits.

"Transfusion may benefit patients with lower hemoglobin levels, less than 7 - 8 g/dL, but the evidence suggests that transfusion for milder anemia in patients with does not improve mortality," said Molly Cooke, MD, FACP, president, ACP.

"The evidence evaluating the impact of ESAs in patients with heart disease did not show improved health outcomes."

ACP's guideline also includes advice to help physicians practice high value care.

Anemia is common in patients with heart disease. Anemia is present in approximately one-third of patients with CHF and 10 to 20 percent of patients with CHD. Anemia can worsen cardiac function and is associated with poor outcomes, including increased risk of hospitalization, decreased exercise capacity, and poor quality of life. It is unclear whether anemia directly and independently leads to these poor outcomes or whether it reflects a more severe underlying illness.

Because of the poor outcomes associated with anemia in patients with heart disease, a number of treatments have been tried, including RBC transfusions, ESAs, and iron replacement. Overall, it is unclear whether these strategies improve outcomes.

Emerging evidence shows short term benefit of one form of intravenous iron in patients with CHF and low ferritin (less than 100), but ACP found evidence lacking on long-term outcomes. Additionally, the effect of oral iron and how it compares to intravenous iron for treating anemic patients with heart disease is unknown.

To develop the guideline, ACP looked at the evidence to answer three questions related to the treatment of anemia in patients with CHF or CHD:

  • What are the health benefits and harms of treating anemia with RBC transfusions?
  • What are the health benefits and harms of treating anemia with ESAs?
  • What are the health benefits and harms of using iron to treat iron deficiency with or without ?

Annals of Internal Medicine also published a summary for patients.

Explore further: Severe anemia linked to poorer heart surgery outcomes

Related Stories

Severe anemia linked to poorer heart surgery outcomes

October 3, 2012

(HealthDay)—Adults undergoing cardiac surgery who have moderate-to-severe preoperative anemia have significantly increased morbidity and mortality compared with non-severely anemic patients, according to research published ...

Recommended for you

No new heart muscle cells in mice after the newborn period

November 5, 2015

A new study from Sweden's Karolinska Institutet shows that new heart muscle cells in mice are mainly formed directly after birth. After the neonatal period the number of heart muscle cells does not change, and A new study ...

Nanotechnology could spur new heart treatment

October 29, 2015

A new nanoparticle developed by University of Michigan researchers could be the key to a targeted therapy for cardiac arrhythmia, a condition that causes the heart to beat erratically and can lead to heart attack and stroke.


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.