Treatment of anemia in patients with chronic heart failure

Anemia is common in heart failure patients and is associated with increased mortality risk. Anemia is multifactorial in etiology and is likely related to the actions of proinflammatory cytokines with consequent reduced red blood cell production and hemodilution secondary to plasma volume expansion. Hemodynamic consequences of anemia may contribute to the progression of heart failure symptoms and ventricular remodeling. Treatment trials with recombinant human erythropoietin in patients with end-stage renal disease and concomitant structural heart disease have demonstrated beneficial effects on cardiac remodeling but variable effects on clinical outcome. Preliminary trials in patients with chronic heart failure demonstrate that erythropoietin therapy is well-tolerated and associated with short-term clinical benefits. Additional studies are needed to investigate the effects of long-term erythropoietic therapy on clinical outcomes.