Recently, it has been suggested that erythropoietin may be useful in the treatment of cardiovascular disease, particularly heart failure. This may be by improving microvascular blood supply and ventricular function through prevention of apoptosis and angiogenesis. Promising results were seen in animals but the few, limited clinical trials have shown modest benefits. Additionally, concerns exist regarding potential serious adverse effects of erythropoietin. Our current understanding of the non-haematopoietic mechanisms of erythropoietin is presented here, with a review of trials to date, and a discussion of the questions that remain over the use of this drug in heart failure.