ACP issues clinical guidelines for treatment of anemia in patients with heart disease

Approximately one-third of patients with congestive heart failure (CHF), and 10% to 20%  of those with coronary heart disease (CHD), also have anemia.

Various strategies have been used to correct anemia in patients with heart disease, recognizing that it can worsen cardiac function and has been associated with a variety of poor outcomes, including an increased risk of hospitalization, decreased exercise capacity, and poor quality of life.

In December, 2013, the Clinical Guidelines Committee of the American College of Physicians (ACP) issued a clinical practice guideline on the treatment of anemia in patients with heart disease. 

The recommendation on red blood cell transfusions was based on low-quality evidence showing a more liberal strategy for intervention (trigger hemoglobin level >10 g/dL) had no benefit for lowering mortality versus the restrictive strategy. The recommendation on use of  erythropoiesis stimulating agents (ESAs) was based on a conclusion that the harms outweigh the benefits. The review found high-quality evidence that ESA treatment did not lower mortality, cardiovascular events, or hospitalizations, moderate-quality evidence that it did not improve quality of life, and studies showing an association with increased risks of thromboembolic events and stroke.

The use of iron to treat iron deficiency with or without anemia in patients with heart disease was also examined. Although there was evidence that one form of intravenous iron (ferrous carboxymaltose-which is not  approved for treatment of anemia in the United States) was associated with a short-term benefit in patients with CHF and ferritin <100 mcg/L, data on long-term outcomes was absent.  There was insufficient evidence to evaluate the effects of oral iron for treating anemia in patients with heart disease.

The guideline also includes information on High Value Care, an ACP initiative to help providers optimize their delivery of care while reducing unnecessary costs to the healthcare system.