Recommendation 116: We recommend erythropoiesis stimulating agents not be routinely used to treat anemia in HF (Strong Recommendation, High Quality Evidence).

Values and preferences: The above recommendation against the use of erythropoiesis-stimulating agents (ESAs) for the treatment of anemia in HFrEF at large was derived from robust data from RCTs.

Patients with severe chronic kidney disease or hemato-oncologic conditions may benefit from an ESA and should be referred to a specialist with expertise in such treatments, for proper initiation and follow-up.