Patients with congestive heart failure (CHF) who are also anemic have more severe CHF and a higher mortality, morbidity, and hospitalization rate than those who are not anemic. However, it is not known if the anemia is actually contributing to the CHF or if it is merely comorbidity (ie a marker of increased inflammation or chronic kidney disease [CKD]). The only way to demonstrate that anemia is a causative factor is to correct it, independent of other CHF factors. In this paper we review the results of the published papers about correction of anemia in patients with CHF. Taken in sum, these reports show a quite consistent positive effect of erythropoietic stimulating agents (ESAs) along with oral or intravenous (IV) iron or even of IV alone on clinical indicators and clinical outcomes of patients with CHF. More work is needed to clarify the important relationship between anemia, CHF, and CKD.
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