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Turma 6

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).

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Turma 6

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  1. Turma 6 Bárbara Vieira, Diana Pires, Iolanda Vieira, João Novo, José Machado, LiaRodrigues, Maria Lume, Mário Sousa, Mónica Pereira, PatríciaGouveia, Pedro Vieira

  2. And Erytropoietin Heart failure! Yes or No?

  3. 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.

  4. Classification of the different grades of CHF New York Heart Association

  5. 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.

  6. 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.

  7. 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

  8. Normal blood oxigen levels Increased O2- carrying ability of blood Reduced O2 levels in blood Kidney releases erythropoietin More RBCs Erythropoietin stimulates Enhanced erythropoiesis Red bone marrow

  9. 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.

  10. Study QuestionDoes the treatment of anaemia with erythropoietin stimulating proteins improve survival and quality of life of severe heart failure patients?

  11. Study Aims 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; Determine complication rates and safety of erythropoietin stimulating proteins treatment.

  12. Methods • Method Systematic Review of Randomized Controlled Trials • Database search Medline Scopus ISI Web of Knowledge

  13. Terms of the search query: Mesh terms: heart failure; anemia; erythropoietin; recombinant. 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.

  14. 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

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