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: ACP recommends against screening for chronic kidney disease in adults without symptoms, risk factors

Related Stories

ACP recommends against screening for chronic kidney disease in adults without symptoms, risk factors

October 21, 2013
The American College of Physicians (ACP) recommends against screening for chronic kidney disease (CKD) in asymptomatic adults without risk factors. ACP's new clinical practice guideline, "Screening, Monitoring, and Treatment ...

Study shows anemia drug does not improve health of anemic heart failure patients

March 11, 2013
Researchers from Cleveland Clinic and Sweden-based Sahlgrenska University Hospital have found that a commonly used drug to treat anemia in heart failure patients –darbepoetin alfa – does not improve patients' health, ...

New research finds link between red cell distribution width levels and depression in heart patients

November 18, 2013
Researchers at the Intermountain Medical Center Heart Institute have discovered a link between elevated red cell distribution width levels and depression in patients being treated for heart disease. This new discovery can ...

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 ...

Scientists far from finish line in understanding anemia in female athletes

November 20, 2013
When Kaitlyn Patterson's fatigue progressed to hyperventilating even during slow runs, and then forced her to quit high school distance running for the season, she knew something was very wrong.

Researchers say it's time to treat anemia seriously

January 24, 2013
Up to one-third of patients undergoing surgery in Ontario have a treatable form of anemia but are not optimally treated for it.

Recommended for you

Could aggressive blood pressure treatments lead to kidney damage?

July 18, 2017
Aggressive combination treatments for high blood pressure that are intended to protect the kidneys may actually be damaging the organs, new research from the University of Virginia School of Medicine suggests.

Quantifying effectiveness of treatment for irregular heartbeat

July 17, 2017
In a small proof-of-concept study, researchers at Johns Hopkins report a complex mathematical method to measure electrical communications within the heart can successfully predict the effectiveness of catheter ablation, the ...

Concerns over side effects of statins stopping stroke survivors taking medication

July 17, 2017
Negative media coverage of the side effects associated with taking statins, and patients' own experiences of taking the drugs, are among the reasons cited by stroke survivors and their carers for stopping taking potentially ...

Study discovers anticoagulant drugs are being prescribed against safety advice

July 17, 2017
A study by researchers at the University of Birmingham has shown that GPs are prescribing anticoagulants to patients with an irregular heartbeat against official safety advice.

Protein may protect against heart attack

July 14, 2017
DDK3 could be used as a new therapy to stop the build-up of fatty material inside the arteries

Heart study finds faulty link between biomarkers and clinical outcomes

July 14, 2017
Surrogate endpoints (biomarkers), which are routinely used in clinical research to test new drugs, should not be trusted as the ultimate measure to approve new health interventions in cardiovascular medicine, according to ...

0 comments

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.