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Heart failure with multiple comorbidities

Moe, Gordon

Current Opinion in Cardiology: March 2016 - Volume 31 - Issue 2 - p 209–216
doi: 10.1097/HCO.0000000000000257
HEART FAILURE: Edited by Haissam Haddad

Purpose of review It is well known that patients with heart failure also suffer from a large number of comorbid conditions, which confound their heart failure management and adversely affect the prognosis. The purpose of this review is to evaluate the latest developments of these conditions.

Recent findings Chronic lung disease commonly coexists with heart failure. It is more prevalent and worsens prognosis more in patients with preserved (heart failure with preserved ejection fraction) than with reduced ejection fraction (heart failure with reduced ejection fraction). Patients with diabetes have increased risk of incident heart failure, and as a comorbid condition it adversely affects prognosis. The relative impact on mortality and heart failure hospitalization remains controversial. Renal dysfunction is also common in patients with heart failure, with similar prevalence among those with preserved ejection fraction and those with reduced ejection fraction. The prognosis seems mainly related to long-term changes in kidney function, rather than to short-term changes in serum creatinine. Anemia and iron deficiency have a similar profile in terms of prevalence and impact on prognosis. Recent data suggest a benefit of intravenous iron infusion in patients who are iron deficient.

Summary As patients with comorbid conditions are frequently excluded from clinical trials, future clinical trials should recruit these patients and include endpoints that will be reflective of these conditions.

St Michael's Hospital, University of Toronto, Toronto, Canada

Correspondence to Gordon Moe, MD, St Michael's Hospital, 30 Bond Street, Toronto, ON M5B1W8, Canada. Tel: +1 416 8645615; e-mail:

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