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. In the largest RCT to date (n=2278), correction of anemia with darbopoetin alfa did not result in benefit and resulted in a significant increase in the risk of thromboembolic events and a nonsignificant increase in fatal and nonfatal strokes, supporting findings from other trials.176,185 188 In summary, the strongest evidence on erythropoietin-stimulating agent therapy in HF suggests lack of benefit and increased adverse events. Therefore, erythropoietin-stimulating agent therapy cannot be recommended in patients with HF and anemia. Table 3. 