Can erythropoiesis-stimulating agents help adults with chronic heart failure and anaemia?
Anaemia is common in chronic heart failure and is linked to worse symptoms and outcomes. Erythropoiesis-stimulating agents (ESAs) are drugs that stimulate red blood cell production to raise haemoglobin levels. A systematic review of 14 trials with over 3,100 participants found that ESAs reduce the total number of heart failure hospitalizations and improve exercise capacity, but they do not reduce the risk of death or first hospitalization. The evidence is moderate quality, so benefits should be weighed against potential risks with your doctor.
What the research says
A 2024 systematic review and meta-analysis pooled data from 14 randomized controlled trials involving 3,128 adults with chronic heart failure and anaemia 2. Over a total follow-up of 5,604 person-years, ESAs did not significantly reduce the risk of a first heart failure hospitalization compared with placebo or no treatment (odds ratio 0.93, 95% CI 0.78–1.10) 2. However, ESAs did significantly lower the total number of heart failure hospitalizations: 622 events per 2,698 person-years in the ESA group versus 761 per 2,914 person-years in the control group (incidence rate ratio 0.81, 95% CI 0.73–0.90) 2. All-cause mortality was not different between groups (odds ratio 1.01, 95% CI 0.86–1.18) 2. Patients receiving ESAs had a mean increase in haemoglobin of 1.6 g/dL and improved exercise tolerance by an average of 69 metres on a six-minute walk test 2. The quality of evidence was moderate, and the risk of bias varied across trials 2. Importantly, these findings are specific to ESAs and not to intravenous iron, which has shown different effects in heart failure patients with iron deficiency 678.
What to ask your doctor
- Given my haemoglobin level and heart failure status, could ESAs reduce my risk of repeat hospitalizations?
- What are the potential side effects of ESAs, such as high blood pressure or blood clots, and how would they be monitored?
- How do ESAs compare with intravenous iron treatments for my specific type of anaemia and iron levels?
- Would my insurance cover ESAs, and what is the typical dosing schedule?
- Should I have my iron levels checked before considering ESA therapy?
This question is drawn from common patient questions about Cardiology and answered using cited medical research. We do not provide individualized advice.