Study question: Mild anemia occurs commonly in patients with heart failure, the detrimental effects of mild to moderate anemia on cardiac function and the effect of correction has not been adequately addressed by controlled studies. Many studies consider anemia to be a rare precipitating cause of heart failure and of hospitalization for heart failure. Silverberg et al. studied the effect of correcting anemia with erythropoietin (EPO) and intra¬venous iron.
Methods: Patients (32) with moderate to severe heart failure class III to IV, and left ventricular ejection fraction of less than 40%, despite optimal doses of heart failure medications and with a hemoglobin level between 10 and 11.5 g/dl were randomized. Group A received subcutaneous EPO and intravenous iron to increase the hemoglobin level to >12.5 g/dl. Group B received no treatment for the anemia.
Results: Over a mean follow up of 8 months, 4 patients in group A died of heart failure. New York heart Association class improved by 42% in A and worsened by 11% in B. The ejection fraction improved approxi¬mately 5% in A and decreased approximately 5% in B.
The serum creatinine did not change in A but increased by 20% in B. Most important, the need for oral and intravenous furosemide decreased by 51 and 91%, respec¬tively, in A, but increased 20%, respectively, in B. Length of hospital stay decreased significantly in A (79%), but increased 57% in B.

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