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Anaemia in Heart Failure — EECC MCQ

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ModerateHeart FailureAnaemia in Heart FailureEECC

A 60-year-old man with stable HFrEF (LVEF 30%) on optimal GDMT has haemoglobin of 88 g/L. Iron studies are normal (ferritin 250, TSAT 28%). MCV is 95 fL. EPO level is inappropriately low. Should erythropoiesis-stimulating agents (ESAs) be used?

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Correct answer: D — No; ESAs are not recommended in HF due to lack of benefit and increased thromboembolic risk in the RED-HF trial

The RED-HF trial (2013) investigated darbepoetin alfa in HFrEF patients with anaemia and showed no reduction in death or HF hospitalisation, with a significant increase in thromboembolic events (including stroke). The ESC HF Guidelines recommend against routine use of ESAs in HF (Class III — harm). Anaemia in HF is often multifactorial (haemodilution, chronic disease, iron deficiency, renal impairment), and treatment should target modifiable causes (iron deficiency → IV iron; renal anaemia → nephrology input). Blood transfusion is reserved for haemodynamically significant anaemia or Hb <70-80 g/L.

Reference: ESC (2023): Focused Update on Heart Failure; RED-HF Trial