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Treating Anemia in Heart Disease Patients

Treating Anemia in Heart Disease Patients

Studies indicate that anemia occurs in about one-third of patients with congestive heart failure and up to 20% of those with coronary heart disease (CHD). The condition has been linked to an increased risk for hospitalizations, decreases in exercise capacity, a poorer quality of life, and higher mortality. The risks and benefits of treating anemia in patients with heart disease are important to understand. Providing Guidance In the Annals of Internal Medicine, the American College of Physicians (ACP) published guidelines that presented the current evidence and provided clinical recommendations on the treatment of anemia and iron deficiency in adults with heart disease. The guideline was based on a review of the literature on anemia and iron deficiency published from 1947 to 2013. The first recommendation made in the guideline was to use a restrictive red blood cell transfusion strategy (trigger hemoglobin threshold of 7 to 8 g/dL, compared with a higher hemoglobin level) in hospitalized patients with CHD. “When compared with a restrictive transfusion strategy, there is low-quality evidence that showed no benefit of using a liberal transfusion strategy in which the trigger threshold for hemoglobin levels was greater than 10 g/dL,” says Amir Qaseem, MD, PhD, who was lead author of the ACP guideline. “This strategy will likely be a slight shift from the aggressive approaches clinicians have used in the past.” ACP also recommends against the use of erythropoiesis-stimulating agents (ESAs) in patients with mild-to-moderate anemia and congestive heart failure or CHD. “This is a strong recommendation that was made on moderate-quality evidence,” says Dr. Qaseem. “We found that the harms of treating patients with mild-to-moderate anemia...

Outcomes in Anemic Patients After Cardiac Valve Replacement

Administering intravenous recombinant human erythropoietin plus iron in anemic patients prior to valve replacement appears to improve postoperative survival and decrease blood transfusion use and hospital length of stay. Spanish researchers found that the combination was independently associated with decreased postoperative morbidity, in-hospital mortality, and postoperative renal failure. Blood cell transfusion rates were 93% for the control group and 57% for the intervention group. Abstract: American Journal of Cardiology, October...
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