A meta-analysis of 5 prospective controlled studies (631 patients) evaluated the effect of intravenous iron on deaths, hospitalizations, and other events in patients with HF and iron deficiency.175 Patients receiving intravenous iron experienced limited but statistically significant improvements in functional capacity and LVEF but no reduction in mortality rate. The FAIR-HF 2 trial is underway to further address the potential benefit of intravenous iron in HF associated with iron deficiency. Therefore, a strong recommendation for intravenous iron repletion must await the results of an appropriately powered trial on morbidity and mortality. There is an uncertain evidence base for oral iron repletion in the setting of anemia associated with HF. Recommendations for Stage C HFpEF (Continued) COR LOE Recommendations Comment/Rationale Yancy et al III: No Benefit B-R In patients with HF and anemia, erythropoietin-stimulating agents should not be used to improve morbidity and mortality.176 NEW: Current recommendation reflects new evidence demonstrating absence of therapeutic benefit. See Online Data Supplement D. Small studies evaluating the treatment of anemia in patients with HF have suggested a trend toward improvement in functional capacity and reduction in hospitalization with the use of erythropoietin-stimulating agents,177 182 but results have varied183 and have been limited because of sample size. Although a meta-analysis of 11 RCTs (n=794) comparing erythropoietin-stimulating agents to control in patients with HF demonstrated significant improvements in 6-minute walk, exercise duration, peak Vo2 , NYHA functional status, EF, BNP, HF-related hospitalizations, and QoL,184 in the STAMINA-HeFT (Study of Anemia in Heart Failure) trial,183 darbepoetin alfa was not associated with significant clinical benefits. 