losartan-potassium and Heart-Failure--Systolic

The recognition of the high prevalence and the independent prognostic role of anemia in heart failure (HF) has contributed to intensification of the search for an effective treatment. A central role of erythropoietin in cardiorenal anemia syndrome has been proposed. Several clinical trials have established the safety and efficacy of erythropoiesis-stimulating agents in correcting anemia in patients with HF. The recognition of the pleiotropic effect of erythropoietin has expanded targets of therapy. The ongoing outcomes trial with darbepoetin alfa will determine the role of this novel therapy in the treatment of HF.

Topics: Anemia; Darbepoetin alfa; Dose-Response Relationship, Drug; Drug Administration Schedule; Erythropoiesis; Erythropoietin; Female; Heart Failure, Systolic; Hematinics; Hemoglobins; Humans; Iron Compounds; Male; Prognosis; Randomized Controlled Trials as Topic; Recombinant Proteins; Risk Assessment; Severity of Illness Index; Treatment Outcome

Patients with systolic heart failure and anemia have worse symptoms, functional capacity, and outcomes than those without anemia. We evaluated the effects of darbepoetin alfa on clinical outcomes in patients with systolic heart failure and anemia.. In this randomized, double-blind trial, we assigned 2278 patients with systolic heart failure and mild-to-moderate anemia (hemoglobin level, 9.0 to 12.0 g per deciliter) to receive either darbepoetin alfa (to achieve a hemoglobin target of 13 g per deciliter) or placebo. The primary outcome was a composite of death from any cause or hospitalization for worsening heart failure.. The primary outcome occurred in 576 of 1136 patients (50.7%) in the darbepoetin alfa group and 565 of 1142 patients (49.5%) in the placebo group (hazard ratio in the darbepoetin alfa group, 1.01; 95% confidence interval, 0.90 to 1.13; P=0.87). There was no significant between-group difference in any of the secondary outcomes. The neutral effect of darbepoetin alfa was consistent across all prespecified subgroups. Fatal or nonfatal stroke occurred in 42 patients (3.7%) in the darbepoetin alfa group and 31 patients (2.7%) in the placebo group (P=0.23). Thromboembolic adverse events were reported in 153 patients (13.5%) in the darbepoetin alfa group and 114 patients (10.0%) in the placebo group (P=0.01). Cancer-related adverse events were similar in the two study groups.. Treatment with darbepoetin alfa did not improve clinical outcomes in patients with systolic heart failure and mild-to-moderate anemia. Our findings do not support the use of darbepoetin alfa in these patients. (Funded by Amgen; RED-HF ClinicalTrials.gov number, NCT00358215.).

Topics: Aged; Anemia; Darbepoetin alfa; Double-Blind Method; Erythropoietin; Female; Heart Failure, Systolic; Hematinics; Hemoglobins; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Proportional Hazards Models; Shock, Septic; Stroke; Thromboembolism; Treatment Failure

Topics: Anemia; Erythropoietin; Female; Heart Failure; Heart Failure, Systolic; Hematinics; Hemodilution; Humans; Male

Topics: Anemia; Erythropoietin; Female; Heart Failure, Systolic; Hematinics; Humans; Male

Topics: Anemia; Erythropoietin; Female; Heart Failure, Systolic; Hematinics; Humans; Male

Topics: Anemia; Erythropoietin; Female; Heart Failure, Systolic; Hematinics; Humans; Male

Topics: Anemia; Erythropoietin; Female; Heart Failure, Systolic; Hematinics; Humans; Male