A New Pathway

Anemia is common among patients with heart failure, probably occurring in approximately 20% of patients, depending on the definition of terms and severity of patient illness. Some anemia is likely dilutional (1), but most is probably true anemia due to chronic disease or iron deficiency (2). The degree of anemia in patients with heart failure after acute myocardial infarction is associated with a poor prognosis (3), and anemia in patients with chronic heart failure from any cause has repeatedly been demonstrated to predict a poor outcome (2). A consensus has seemingly emerged in the heart failure community that correction of a reduced hemoglobin (Hb) level is an attractive therapeutic target deserving of further study. Of interest, erythropoietin (EPO) levels are moderately elevated in patients with heart failure, more so in very severe heart failure (4). This finding has not discouraged pharmaceutical companies from testing the concept of using EPO and its analogues as possible treatment for heart failure. This is clearly a case where treatment precedes understanding of pathophysiology, a common occurrence throughout history.