Anemia in heart failure: to treat or not to treat?

Anemia is a prevalent comorbidity in chronic heart failure (CHF). As studies have demonstrated close links between anemia and a poorer prognosis, there has been an interest in developing treatment strategies for this condition. Anemia is closely associated with disease severity and may be secondary to multiple modifiable causes; therefore, the initial strategies should always include a thorough search for etiology and should focus on optimizing heart failure treatment. Recently, more specific therapies have been assessed, namely erythropoiesis-stimulating agents and iron supplementation therapy. Studies evaluating erythropoietin in heart failure have demonstrated conflicting results to date, with smaller, single-center studies seeming to show a clinical benefit and larger, multicenter trials demonstrating no significant effect on clinical outcome aside from improvement in selected quality-of-life indices. Similarly, studies evaluating iron therapy alone in anemic patients with heart failure have so far shown promising results with regard to clinical and quality-of-life outcomes, but these studies are limited in that they involved small patient numbers. Ongoing studies such as the Reduction of Events With Darbepoetin Alfa in Heart Failure (RED-HF), Iron Supplementation in Heart Failure Patients With Anemia (IRON-HF), and Ferinject Assessment in Patients With Iron Deficiency and Chronic Heart Failure (FAIR-HF) trials will determine the value of darbepoetin alfa and intravenous iron replacement therapy in anemic CHF patients.