Horwich et al. analyzed a cohort of 1061 patients with severe heart failure. The survival at one year was higher in patients with increased hemoglobin levels. They concluded that in chronic heart failure relatively mild degrees of anemia are associated with worsened symptoms, functional class, and survival.
Mozaffarian et al., using a prospective cohort design, evaluated the relationship between baseline serum hema-tocrit and mortality among 1130 patients with a left ventricular ejection fraction less than 30% treated with ACE inhibitors, diuretics, and digitalis. Follow up at 15 months showed 407 deaths in those with a hematocrit of 25–37%; these patients had a 52% higher risk of death compared with those with a normal hematocrit of 46– 58%. In patients with severe heart failure, anemia is a significant independent risk factor for death with a pro¬gressively higher risk with increasing severity of anemia. The etiology, prevention, and treatment of anemia in severe heart failure require further investigation to improve survival rates.
Correction of anemia in patients with heart failure has been shown in this study to be most beneficial. Treatment with EPO and intravenous iron caused marked improve¬ment in heart function and was associated with a signi¬ficant reduction in hospitalization, renal impairment, and the need for diuretics. Correction of the anemia also enhances the standard therapy for heart failure. Silverberg et al. stated that it is surprising, judging from the literature on heart failure, that such an obvious treatment for improving heart failure is so rarely considered.

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