Treatment of anemia in the patient with heart failure

Anemia is common among patients with chronic heart failure (CHF) and is associated with increased morbidity and mortality. The data suggest that correction of anemia in patients with CHF is beneficial in terms of exercise capacity, New York Heart Association functional class, hospitalization rates, and quality of life. It is not known whether the correction of anemia in this group of patients will improve survival. Small-scale studies in patients with CHF have reported correcting anemia with erythropoietin and oral or intravenous iron. However, the optimal regimen for correction of anemia in patients with CHF has yet to be defined. Significant questions that remain to be answered are the following: which subset of patients with CHF would receive the greatest benefit, when to initiate anemia correction, what dosage of erythropoietin or other agent is appropriate, what target hemoglobin level is to be achieved, and how mortality will be impacted. A cost-benefit analysis is also required. At this point, the treatment of anemia in patients with CHF is not the standard of care and should only be initiated in an investigational setting.