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Anemia in Heart Failure With a Preserved Ejection Fraction (HFPEF)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT00286182
Recruitment Status : Completed
First Posted : February 3, 2006
Results First Posted : June 10, 2016
Last Update Posted : March 10, 2017
National Institute on Aging (NIA)
Information provided by (Responsible Party):
Mathew S. Maurer, Columbia University

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.

Condition or disease Intervention/treatment Phase
Anemia Drug: Erythropoietin alpha Drug: Placebo Phase 2

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.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 56 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Efficacy of Treating Anemia in Heart Failure With a Preserved Ejection Fraction (HFPEF) on Ventricular Function, Exercise Capacity and Health Status
Study Start Date : July 2007
Actual Primary Completion Date : November 2012
Actual Study Completion Date : November 2012

Resource links provided by the National Library of Medicine

Arm Intervention/treatment
Experimental: 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.
Drug: Erythropoietin alpha
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.
Other Name: Erythropoietin alpha (Epogen)

Placebo Comparator: Placebo
Placebo consists of saline injections.
Drug: Placebo

Primary Outcome Measures :
  1. Change in Left Ventricular End-diastolic Volume [ Time Frame: Baseline and 6 month ]
    This outcome measure is collected using a three dimensional echocardiography.

Information from the National Library of Medicine

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Ages Eligible for Study:   55 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts 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

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT00286182

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United States, New York
Clinical Cardiovascular Research Laboratory for the Elderly
New York, New York, United States, 10034
Sponsors and Collaborators
Mathew S. Maurer
National Institute on Aging (NIA)
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Principal Investigator: Mathew S Maurer, MD Columbia University

Publications automatically indexed to this study by Identifier (NCT Number):
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Responsible Party: Mathew S. Maurer, Associate Professor of Clinical Medicine, Columbia University Identifier: NCT00286182    
Other Study ID Numbers: AAAB3037
R01AG027518-01 ( U.S. NIH Grant/Contract )
First Posted: February 3, 2006    Key Record Dates
Results First Posted: June 10, 2016
Last Update Posted: March 10, 2017
Last Verified: January 2017
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Undecided
Keywords provided by Mathew S. Maurer, Columbia University:
Heart Failure
Diastolic Dysfunction
Ventricular End Diastolic Volume
Additional relevant MeSH terms:
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Heart Failure
Heart Diseases
Cardiovascular Diseases
Hematologic Diseases
Epoetin Alfa