842-6 Anemia is associated with reduced health status measures in patients with heart failure: Results from the STAMINA: HFP (study of anemia in a heart failure population) registry

BACKGROUND Recent studies have shown that anemia is a common comorbid condition in patients with chronic heart failure (CHF), suggesting an impact on history and prognosis. AIM To investigate the mechanisms of anemia in a series of consecutive anemic CHF patients and define a rational therapeutic approach. METHODS A series of 148 consecutive adult CHF pts with Hb <13 g/dL (males) or <12 g/dL (females) was studied. Potential responsible factors for anemia were investigated by evaluating endogenous erythropoietin (Epo) production, serum cytokines levels (TNFalpha and its soluble receptors, IL-6 and IL-1Ra), body iron status, and iron supply for erythropoiesis. RESULTS 105 pts (71%) had evidence of severe defective endogenous erythropoietin production, indicated by an observed/predicted log(serum Epo) ratio <0.8; 85 pts (57%) had low serum iron (mean value for men 105, for women 45 ng/mL; 61 (41%) had low transferrin saturation (mean value 22% for men and 23% for women) and 85 (57%) had increased levels for soluble transferrin receptor. Impaired iron supply to erythropoiesis, as indicated by low transferrin saturation and/or increased values for soluble transferrin receptor, was observed in 105 pts (71%). Elevated values for high sensitivity C-reactive protein (mean value 0.69 for men and 0.61 mg/dL for women) were found in 83 pts (56%), increased serum creatinine in 44 pts (30%), cytokines activation in 133 pts (90%). CONCLUSION Our findings demonstrate that the vast majority of anemic CHF pts shows evidence of blunted endogenous erythropoietin production and/or defective iron supply for erythropoiesis. Therefore, the assessment of serum erythropoietin and the evaluation of body iron status represent a rational approach to treatment of the individual patient: according to those physiopathologic findings in most instances, subcutaneous administration of recombinant human erythropoietin combined with iv iron would represent the optimal therapeutic approach.