Transcript Heart Failure (HF)

Turma 6
Bárbara Vieira,
Diana Pires,
Iolanda Vieira,
João Novo,
José Machado,
Lia Rodrigues,
Maria Lume,
Mário Sousa,
Mónica Pereira,
Patrícia Gouveia,
Pedro Vieira
Erytropoietin
And
Heart failure!
Yes or No?
Chronic Heart Failure (CHF)
•
Condition in which the heart is unable to
pump out sufficient blood to meet the
metabolic need of the body.
•
Can be caused by structural defects,
functional
abnormalities
(ventricular
dysfunction). [1]
[1] Kenneth D., Alain C., et al. ESC Guidelines for the diagnosis and treatment of acute and
chronic heart failure 2008. Eur. HeartJ. 2008; 29: 2388-2442.
Classification of the different grades of CHF
Class
Patient Symptoms
Class I (Mild)
No limitation of physical activity.
Class II (Mild)
Slight limitation of physical activity.
Class III
(Moderate)
Class IV (Severe)
Marked limitation of physical activity.
Unable to carry out any physical activity
without discomfort.
New York Heart Association
Anaemia
•
Anemia is defined as a qualitative or
quantitative deficiency of hemoglobin
•
According to the World Health Organization
(WHO) Haemoglobin concentration <12g/dL
in women and <13g/dL in men indicates the
presence of anemia. [2]
[2]Vedhuisen D., Dickstein K., et al. Randomized double-blind, placebo- controlled study to evaluate the effect
of two dosing regimens of darbepoetin alfa in patients with heart failure and anaemia. Eur. HeartJ.2007;28.
Anaemia in CHF
• Prevalence of anaemia depends both on the
severity of CHF and diagnostic criteria used to
define it [3]
• Anaemia is present in one-third of the CHF
patients (WHO) [3]
[3] Dunlay S., Weston S., et al. Anemia and heart failure: A community study. Acad Med 2008; 121: 726-732.
Erythropoietin (EPO)
• Erythropoietin (EPO) is a glycoprotein
hormone secreted chiefly by the kidney.
• The kidney cells that make EPO are sensitive to
low oxygen levels in the blood coming into the
kidney. These cells make and release EPO
when the oxygen level is too low
Normal blood oxigen levels
Increased O2- carrying ability of blood
Reduced O2 levels in blood
Kidney releases erythropoietin
More RBCs
Erythropoietin stimulates
Enhanced erythropoiesis
Red bone marrow
Erythropoietin in other diseases
•
Oncology
- Quimioterapy reduces the levels of red blood
cells. [4]
•
Kidney failure
- There is no production of erythropoietin. [5]
[4]Crawford J., Recombinant human erythropoietin in cancer-related anemia. Review of clinical evidence.
Oncology 2002;16: 41-53
[5]Michael J., Lloyd I., et al. Impact of epoetin alfa on clinical end points in patients with chronic renal failure: A
meta-analysis.Kidney International 2004; 65: 757–76.
Study Question
Does the treatment of anaemia with
erythropoietin stimulating proteins
improve survival and quality of life of
severe heart failure patients?
Study Aims
1. Evaluate if severe heart failure patients with anaemia
treated with erythropoietin stimulating proteins have
reduction in mortality rates and improvement in the
prognosis: readmission rates, NYHA functional class
and the improvement in the quality of life;
2. Determine
complication
rates
and
erythropoietin stimulating proteins treatment.
safety
of
Methods
• Method
Systematic Review of Randomized Controlled Trials
• Database search
Medline
Scopus
ISI Web of Knowledge
Terms of the search query:
1. Mesh terms: heart failure; anemia; erythropoietin;
recombinant.
2. Text Words: heart failure; congestive heart failure;
chronic heart failure; heart insuficiency; systolic
dysfunction; symptomatic heart failure; anemia; epoetin
delta; erythropoiesis stimulating protein, human;
darbepoetin alfa; recombinant erythropoietin;
erythropoietin; erythropoietin recombinant.
Query
•For PubMed search:
("Heart Failure“ [Mesh] OR "heart failure“ [All Fields] OR
"congestive heart failure“ [All Fields] OR "chronic heart failure“
[All Fields] OR "systolic dysfunction“ [All Fields] OR
"symptomatic heart failure“ [All Fields]) AND ("Anemia“ [Mesh]
OR "anaemia“ [All Fields] OR "anemia“ [All Fields]) AND
("Erythropoietin, Recombinant“ [Mesh] OR "epoetin delta“
[Substance Name] OR "erythropoiesis stimulating protein,
human“ [Substance Name] OR "darbepoetin alfa“ [Substance
Name] OR "recombinant erythropoietin“ [All Fields] OR
"erythropoietin“ [All Fields] OR "erythropoietin“ [MeSH Terms]
OR "erythropoietin recombinant“ [All Fields])
•For ISI Web of Knowledge, Cochrane and Scopus the
query is the same with slight modifications
Exclusion Criteria
Inclusion Criteria
- Comparison of erythropoietin with other - Randomized controlled clinical trial
drugs
- Full article isn’t available
- Erythropoietin group or erythropoietin +
iron therapy vs placebo group or iron
therapy
- Animal experimentation
- Articles where in the 2 groups the heart
failure treatment is optimise
-Articles not from Journal of the American - Articles that evaluate prognosis, mortality
College neither from European Heart and quality of life
Journal (scopus)
- Article in other language which not English
or Portuguese
- Articles that study erythropoietin therapy in
other diseases (not heart failure)
- Review
editorials
articles,
letters,
comments,