losartan-potassium and Cardiac-Output--Low

Several studies showed that anaemia is commonly observed in patients with Chronic Heart Failure (CHF) and is associated with worsened symptoms and survival. When anaemia in these patients is treated with erythropoietin (EPO), a significant improvement in cardiac function and symptoms was observed. Although it was originally believed that EPO specifically acted on haematopoietical cells, recent evidence demonstrated several non-haematopoietical effects. Ischaemia/reperfusion experiments in rat heart and brain showed large infarct reduction when treated with EPO. Other effects of EPO are related to its pro-angiogenic effects on endothelial cells, which could be of potential value in patients with ischaemic heart disease. These preclinical findings suggest that EPO may have potential effects in cardiovascular disease beyond correction of haemoglobin levels.

Topics: Anemia; Apoptosis; Cardiac Output, Low; Cardiovascular Diseases; Chronic Disease; Erythropoietin; Humans; Kidney Failure, Chronic; Myocardial Ischemia; Neovascularization, Pathologic; Recombinant Proteins; Stroke

Many patients with chronic diseases such as chronic renal failure, chronic inflammatory bowel disease and rheumatoid arthritis are anaemic. Recently congestive heart failure (CHF) has also been found to be associated with anaemia. In all these diseases this anaemia or chronic disease is at least partially due to excessive production of cytokines and leukotrines that interfere both with the effect of erythropoietin (EPO) at the bone marrow and the release of stored iron in the reticuloendothelial system. Treating this anaemia with subcutaneous EPO and IV iron improves the weakness, fatigue, cachexia, nutritional state, mood, cognitive function and quality of life. In the case of CHF it also improves cardiac function and patient functional class, prevents deterioration of renal function and markedly reduces hospitalization. Very few agents in medicine improve so many aspects of the patient so well and so quickly. Unfortunately (for the suffering patient) this anaemia is often ignored and goes untreated.

Topics: Anemia; Cardiac Output, Low; Chronic Disease; Erythropoietin; Humans; Iron; Kidney Failure, Chronic; Recombinant Proteins

Topics: Anemia; Animals; Brain Injuries; Cardiac Output, Low; Critical Illness; Erythropoietin; Gene Expression Regulation; Genetic Therapy; Humans; Kidney Diseases

In patients with chronic heart failure (CHF), anemia is associated with more severe symptoms and worse prognosis. Erythropoiesis-stimulating proteins (ESPs) increase hemoglobin and may be of therapeutic benefit. We investigated the pharmacokinetics and pharmacodynamics of the long-acting ESP, darbepoetin alfa, administered on 2 occasions 1 month apart to 30 healthy subjects and 33 patients with symptomatic CHF and anemia (hemoglobin

Topics: Aged; Anemia; Biological Availability; Cardiac Output, Low; Chronic Disease; Cross-Over Studies; Darbepoetin alfa; Double-Blind Method; Drug Administration Schedule; Erythropoietin; Female; Hemoglobins; Humans; Injections, Intravenous; Injections, Subcutaneous; Male; Middle Aged

To determine the prevalence of anemia in an outpatient heart failure clinic, describe the type of anemia in patients treated there, and evaluate the potential costs associated with epoetin therapy in this cohort.. Single-center, retrospective cohort analysis (part 1) and a literature-based economic decision analysis (part 2).. Medical records from a multidisciplinary, outpatient, heart failure clinic, and published hospitalization and drug-use data.. We evaluated 170 adults with chronic heart failure who were enrolled in the clinic and for whom at least one complete blood count was recorded between January 1, 2003, and April 15, 2006.. In part 1, demographic and clinical data were extracted from electronic medical records. The overall prevalence of anemia was 47.6% or 47.1%, as based on World Health Organization or National Kidney Foundation definitions, respectively. Normocytic anemia was characterized in 75.0% of patients. In part 2, heart failure hospitalization rates and costs, drug acquisition, and drug administration were estimated by using the published literature. In a hypothetical cohort of 100 patients with heart failure and comorbid anemia, the costs associated with outpatient epoetin and intravenous iron therapy exceeded savings in hospitalization costs by $83,070. Results of 1-way sensitivity analyses generally confirmed robustness of the model.. Anemia is a common comorbidity in patients with chronic heart failure treated in the outpatient clinic. Although the current evidence is insufficient to support the use of epoetin in this population, initial findings indicate that epoetin and intravenous iron therapy may be associated with positive clinical outcomes. From a pharmacoeconomic standpoint, however, a reduction in the cost of heart failure-related hospitalization does not offset the cost of epoetin and intravenous iron therapy.

Topics: Adult; Aged; Aged, 80 and over; Ambulatory Care Facilities; Anemia; Cardiac Output, Low; Chronic Disease; Cohort Studies; Cost-Benefit Analysis; Costs and Cost Analysis; Decision Support Techniques; Epoetin Alfa; Erythropoietin; Female; Health Care Costs; Hematinics; Hospitalization; Humans; Iron; Male; Middle Aged; Prevalence; Recombinant Proteins; Retrospective Studies

Topics: Anemia; Cardiac Output, Low; Darbepoetin alfa; Epoetin Alfa; Erythropoiesis; Erythropoietin; Humans; Iron; Oxygen Consumption; Recombinant Proteins; Risk Factors

Topics: Anemia; Cardiac Output, Low; Chronic Disease; Erythropoietin; Humans