Anemia is a common finding in chronic heart failure (CHF). Anemia develops due to CHF, but is also known to cause heart failure. Patients with CHF are limited by exercise capacity and fatigue. Low hemoglobin concentration can account for both and may substantially contribute to the symptoms of CHF. Increasing severity of CHF is associated with a higher frequency of anemia, which also becomes clinically more relevant. Anemia has been shown to predict impaired survival in CHF, independent of established prognostic markers. There are many potential reasons for development of anemia in CHF, such as bone marrow depression, reduced intestinal iron uptake and hemodilution as a consequence of sodium and water retention. In most cases, however, anemia in CHF should be viewed as "anemia of chronic illness", being the result of a combination of many factors related to the disease, particularly chronic inflammation. The option of therapeutically targeting anemia in CHF is an intriguing novel approach to improve morbidity and potentially mortality in these patients.