Anemia in patients with a recent acute myocardial infarction complicated by
heart failure is associated with an increased risk of hospitalization and
mortality, according to a report in the June issue of the European Heart
Journal.

"Anemia in heart failure patients carries a poor prognosis, and these patients
should be more carefully monitored and treated," Dr. Adriaan Voors from
University Medical Center Groningen in the Netherlands told Reuters Health.

Dr. Voors and colleagues in the OPTIMAAL (Optimal Trial in Myocardial Infarction
with the Angiotensin II Antagonist Losartan) study investigated the association
between hemoglobin levels and outcomes in 3621 patients who developed heart
failure after myocardial infarction.

Lower baseline hemoglobin was strongly related to death and heart failure
hospitalizations, the authors report, with each standard deviation increase in
hemoglobin decreasing the risk of death by 12%.

In a multivariable analysis, each standard-deviation decrease in hemoglobin over
12 months was associated with a 27% increase in mortality risk after adjusting
for other potential risk factors, and the survival benefit associated with each
standard-deviation increase in hemoglobin over the same period was 33% after
adjustment for the same covariates.

Hemoglobin level was not independently associated with several inflammatory
markers, the researchers note, including high sensitivity C-reactive protein.

"Since anemia is a very consistent and strong predictor of mortality in patients
with acute myocardial infarction and heart failure, one might assume the
correction of anemia using erythropoiesis-stimulating proteins might be
beneficial," the investigators suggest.

"Phase II studies with EPO (erythropoietin) in heart failure patients show
modest, but promising results," Dr. Voors said. "A large phase III study
(RED-HF) is ongoing."

"The potential beneficial effects of EPO in heart failure patients might also be
independent of its effects on anemia," Dr. Voors explained. "We have
demonstrated in experimental studies that EPO induces cardiac neovascularization
and decreases myocardial apoptosis. Also, experimentally, the beneficial effects
of EPO in our experimental models were seen in doses that did not influence
hematocrit."

Eur Heart J 2009;30:1331-1339.