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Erythropoietin is a growth factor that is the main stimulus for erythrocyte production. Because anemia is recognized as a common comorbidity in older adult patients with heart failure, the use of erythropoietin within this cohort has been embraced as a potential therapy for improving outcomes including quality of life. Clinical trials of erythropoietin in systolic heart failure have demonstrated several positive effects of the drug on cardiovascular structure and function and exercise capacity. However, the promising results of these studies are often offset by small sample sizes, absence of enrollment of patients > 75 years of age, those with preserved ejection fraction heart failure (HFPEF), and the potential for serious adverse side effects. The pleiotropic effects of erythropoietin therapy including both hematopoietic and non-hematopoietic actions are relevant especially for older adults with HFPEF in whom multiple mechanisms produce the observed phenotype and for whom the adverse effects of therapy are heightened. The successes of erythropoietin administration within the older adult heart failure population remain to be tested in large clinical trials that will provide clear evidence of safety and efficacy. For such trials, we highlight erythropoietin dosing, implementation of run-in periods, and methods to identify the group of older adults, particularly susceptible to erythropoietin’s side effects, who are poor responders to the drug. Collectively, such information is essential to adequately delineate the role of erythropoietin therapy within the aging heart failure population. |
