Anemia
Conditions
Keywords
Heart Failure, Elderly, Diastolic Dysfunction, Anemia, Ventricular End Diastolic Volume, Aged
Brief summary
The purpose of this study is to determine if treating anemia with subcutaneous erythropoetin in patients with heart failure and a preserved ejection fraction (HFPEF) will be associated with reverse ventricular remodeling, significant improvements in exercise capacity, and improved health status, as compared with placebo.
Detailed description
Heart failure frequently occurs in patients with a preserved ejection fraction (HFPEF) and affected subjects are predominantly elderly women with several co-morbid conditions. Despite the diversity of underlying clinical pathologies and co-morbid conditions present in these patients, a common pathophysiologic explanation is generally applied to explain their clinical symptoms. Our preliminary data show that a significant subgroup with HFPEF has increases in ventricular volumes and expanded plasma volumes, consistent with a volume overloaded state. In the setting of a preserved EF with end diastolic volume increased, stroke volume must increase, indicating a high output state. Anemia may be an important, modifiable contributor to the observed high output and volume overload as well as exercise intolerance in elderly HFPEF patients, abnormal ventricular remodeling and impaired overall health status and quality of life. This protocol evaluates the impact of treating anemia in subjects with HFPEF. The specific aims of the current study are to provide a comprehensive and mechanistically based assessment of how correcting anemia in subjects with HFPEF can impact on functional capacity, ventricular structure and function and overall health status. We propose to perform a randomized, prospective, double blind study in 80 subjects with HFPEF to test the hypothesis that the administration of subcutaneous erythropoietin will be associated with reverse ventricular remodeling, significant improvements in exercise capacity and improved health status.
Interventions
Erythropoietin alpha is administered weekly by subcutaneous injection using a pre-specified dosing algorithm. The dosing algorithm is designed to make adjustments based on the rate of rise (ROR) of the hemoglobin over a one week period, as well as the absolute hemoglobin value. Subjects initially received active treatment with 7,500 units of erythropoietin given weekly by subcutaneously injection. Subjects are carefully monitored (e.g. every week) to avoid rapid increases in hemoglobin/hematocrit and/or increasing blood pressure control. Dose adjustments are made if the hemoglobin rises too rapidly (greater than 0.3 g/dL) in any given weekly interval.
DRUGPlacebo
Placebo
Sponsors
National Institute on Aging (NIA)
Mathew S. Maurer
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
55 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Heart failure and a preserved ejection fraction (HFPEF) - EF \>=40% 2. Anemia - defined as hemoglobin \< 12 g/dL 3. Age \>= 55 years 4. Patients must be able to understand and sign the informed consent document after the nature of the study has been fully explained, prior to beginning any study procedures.
Exclusion criteria
1. Presence of uncontrolled hypertension (Systolic blood pressure \> 160 mm Hg and/or diastolic blood pressure \> 90 mm Hg) 2. Resting heart rate \> 120 bpm 3. Baseline 6-minute walk test \> 450 meters 4. Valvular heart disease (e.g. more than mild regurgitant or stenotic mitral, aortic, tricuspid, or pulmonic valve disease). 5. Infiltrative cardiac disease such as hemochromatosis and amyloidosis 6. Hypertrophic cardiomyopathy 7. Chronic pulmonary disease (FEV 1 \< 60% predicted) 8. Renal failure (GFR \< 15 ml/min) 9. Hemoglobin \< 8 g/dL 10. BMI \> 40 11. Exercise limited by angina, claudication, orthopedic, or neurological diseases. 12. Severe liver dysfunction that is defined by an international normalized ratio \> 2.0, not caused by an anticoagulant. 13. Current or recent treatment (within past 6 months) with erythropoietin 14. Erythropoietin level \> 100 mU/ml 15. Recent cardiac surgery (\< 3 months) 16. Known iron deficiency anemia from chronic GI blood loss, uterine bleeding, or other chronic bleeding 17. Planned surgery during the course of the study 18. Significant alcohol use or illicit drug use. 19. Patients with a known hypercoagulable state. 20. Active hematologic disease (e.g. sickle cell anemia, thalassemia, chronic myelogenous leukemia) or malignancy 21. Patients with current seizure disorder or activity 22. Patients who are known to be pregnant 23. History of deep venous thrombosis (DVT) or pulmonary embolus (PE) within 12 months before study entry. Prior superficial thrombophlebitis is not an exclusion criterion. 24. History of cerebrovascular accident (CVA) within 6 months 25. History of transient ischemic attack (TIA) within 6 months 26. History of acute coronary syndrome (ACS), or other arterial thrombosis within 6 months before study entry. ACS includes unstable angina, Q wave myocardial infarction (QwMI), and non-Q wave myocardial infarction (NQMI). 27. Allergy or sensitivity to human serum albumin 28. Known hypersensitivity to mammalian cell-derived products
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Left Ventricular End-diastolic Volume | Baseline and 6 month | This outcome measure is collected using a three dimensional echocardiography. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Erythropoietin Alpha Subcutaneous erythropoietin will be administered once weekly to achieve a target hemoglobin of 13 g/dL. Subjects will be dosed with the study drug for 24 weeks. The administration of study drug will be performed according to a pre-specified treatment algorithm that adjust erythropoietin dosages based on the rate of rise of the hemoglobin. | 28 |
| Placebo Placebo consists of saline injections.
Placebo: Placebo | 28 |
| Total | 56 |
Baseline characteristics
| Characteristic | Erythropoietin Alpha | Placebo | Total |
|---|---|---|---|
| Age, Continuous | 79 years STANDARD_DEVIATION 11 | 74 years STANDARD_DEVIATION 9 | 76.5 years STANDARD_DEVIATION 10 |
| Region of Enrollment United States | 28 participants | 28 participants | 56 participants |
| Sex: Female, Male Female | 18 Participants | 20 Participants | 38 Participants |
| Sex: Female, Male Male | 10 Participants | 8 Participants | 18 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 0 / 28 | 0 / 28 |
| serious Total, serious adverse events | 19 / 28 | 18 / 28 |
Outcome results
Primary
Change in Left Ventricular End-diastolic Volume
This outcome measure is collected using a three dimensional echocardiography.
Time frame: Baseline and 6 month
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Erythropoietin Alpha | Change in Left Ventricular End-diastolic Volume | -6 mL | Standard Error 14 |
| Placebo | Change in Left Ventricular End-diastolic Volume | -4 mL | Standard Error 16 |