The Use of EPO- Stimulating Agents in Heart Failure Nora Sharaya, PharmD PGY2 Pharmacotherapy Resident Butler University & Community Health Network This speaker has no actual or potential conflicts of interest to disclose in relation to this presentation
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The Use of EPO-Stimulating Agents in Heart Failure
The Use of EPO-Stimulating Agents in Heart Failure. Nora Sharaya, PharmD PGY2 Pharmacotherapy Resident Butler University & Community Health Network This speaker has no actual or potential conflicts of interest to disclose in relation to this presentation. - PowerPoint PPT Presentation
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The Use of EPO-Stimulating Agents in Heart Failure
Nora Sharaya, PharmDPGY2 Pharmacotherapy ResidentButler University & Community Health Network
This speaker has no actual or potential conflicts of interest to disclose in relation to this presentation
The Link Between Anemia and Heart Failure
AnemiaHemodilution
Functional Iron
Deficiency
Activation of the
Inflammatory Cascade
Impaired EPO Production
Concomitant CKD
ISRN Hematol 2012; 2012: 246915
HF with preserved EF
HF with unpreserved
EF
Anemia
The Link Between Anemia and Heart Failure
ISRN Hematol 2012; 2012: 246915
A meta-analysis published in 2008 examined 153,180 patients with chronic heart failure Of those patients, 37.2% were anemic
After a minimum of six months follow up, 46.8% of patients with anemia died compared to 29.5% of the patients without anemia Based on these results, in patients without an identifiable
cause for their anemia, using erythropoietin-stimulating agents has been considered
Mortality
J Am Coll Cardiol. 2008;52:818–2.
Increased Risk of Mortality
Reduced Exercise Capacity
Impaired Quality of Life
Increased Risk of Hospitalization
Complications
J Am Coll Cardiol 2008;52:818–2
Acknowledge the link between anemia and heart failure• Discuss associated complications
No cited recommendation on use of EPO stimulating agents for treatment• Lack of definitive evidence
ACCF/AHA Guidelines
Circulation. 2013; 128: e240-e327.
US Boxed Warning:
“Erythropoiesis-stimulating agents (ESAs) increased the risk of serious cardiovascular events, thromboembolic events, stroke, and mortality in clinical studies when administered to target hemoglobin levels >11 g/dL.”