1. We suggest that for patients with documented iron deficiency, oral or intravenous iron supplement be initiated to improve functional capacity. (Weak Recommendation, Low-Quality Evidence).
2. We recommend erythropoiesis stimulating agents not be routinely used to treat anemia in heart failure. (Strong Recommendation, High-Quality Evidence).

Values and Preferences: The iron supplement recommendation was derived mostly from the experience of clinicians, small clinical trials, and 2 large randomized controlled trials (RCTs). The recommendations against the use of erythropoiesis-stimulating agents (ESAs) were derived from robust data from RCTs.

Practical Tip: Patients with severe chronic kidney disease and anemia should be referred to a nephrologist to seek the optimal therapy for anemia.

Symptomatic patients with low transferrin and/or ferritin levels should be considered for supplementary iron therapy principally with a goal of improving symptoms.