turma 6
DESCRIPTION
Turma 6. Bárbara Vieira, Diana Pires , Iolanda Vieira, João Novo, José Machado, Lia Rodrigues , Maria Lume , Mário Sousa, Mónica Pereira, Patrícia Gouveia , Pedro Vieira. And. Erytropoietin. Heart failure!. Yes or No?. Chronic Heart Failure (CHF). - PowerPoint PPT PresentationTRANSCRIPT
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
Yes or
No?
An
d Heart
failure!
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)
Marked limitation of physical activity.
Class IV (Severe)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
More RBCs
Normal blood oxigen levels
Reduced O2 levels in blood
Kidney releases erythropoietin
Erythropoietin stimulates
Red bone marrow
Increased O2- carrying ability of blood
Enhanced erythropoiesis
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 safety of
erythropoietin stimulating proteins treatment.
Methods
• Method
Systematic Review of Randomized Controlled Trials
• Database searchMedline
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 drugs
- Randomized controlled clinical trial
- 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 College neither from European Heart Journal (scopus)
- Articles that evaluate prognosis, mortality and quality of life
- Article in other language which not English or Portuguese
- Articles that study erythropoietin therapy in other diseases (not heart failure)
- Review articles, letters, comments, editorials