A comorbidity is defined as a disease or other pathologic process that occurs simultaneously with a primary illness.1 As the population ages combined with improvements in modern medicine, it is anticipated that the comorbity burden in heart failure patients will continue to increase.1 It is currently estimated that more than two-thirds of patients with heart failure have two or more non-cardiac comorbidities and that more than one-quarter have 6 or more coexisting diseases.2 Comorbidities are important in patients with heart failure because of the negative impact they can have on patient outcomes:
- Comorbidities may influence treatment options for heart failure (e.g. it may not be possible to use renin-angiotensin system inhibitors in some patients with renal dysfunction as they may cause worsening renal function and hyperkalemia).3
- The drugs used to treat comorbidities may cause worsening of heart failure (e.g. NSAIDs and COX-2 inhibitors given prescribed for arthritis as they may cause sodium and water retention, worsening renal function and worsening heart failure).3
- The drugs used to treat heart failure and those used to treat comorbidities may also interact with one another (e.g. non-cardioselective beta-blockers inhibit beta-agonist therapeutic response and many physicians are hesitant to prescribe beta-blockers to heart failure patients with COPD or asthma due to the possibility of bronchconstriction).3
- Most comorbidities are associated with worse clinical status and adversely impact patient management and clinical course.3
Attention to the diagnosis and management of comorbidities in patients with heart failure may lead to the development of treatment strategies that improve patient outcomes.
Chronic heart failure is a complex clinical syndrome involving multiple organ systems characterized by cardiac dysfunction that is rooted in the pathophysiologic consequences of the long-term activation of neuroendocrine, immune, and musculoskeletal systems.4 These, once activated, can promote a complex pathophysiologic scenario involving the heart and lung as well as other organ systems, leading to the development of medical complications such as:
- Cardiac cachexia
- Chronic obstructive pulmonary disease
- Erectile Dysfunction
- Gastrointestinal dysfuction
- Iron Deficiency
- Liver dysfunction
- Prostatic obstruction
- Renal failure
- Sleep disturbance and sleep-disordered breathing
1. Page R, II, Lindenfeld J. The Comorbidity Conundrum: A Focus on the Role of Noncardiovascular Chronic Conditions in the Heart Failure Patient. Curr Cardiol Rep 2012;14:276-284.
2. Abete P, Testa G, Della-Morte D et al. Treatment for chronic heart failure in the elderly: current practice and problems. Heart Fail Rev 2013;18:529-551.
3. Task FM, McMurray JJV, Adamopoulos S et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J 2012;33:1787-1847.
4. Mendzef SD, Slovinski JR. Neurohormones and heart failure. Nursing Clinics of North America 2004;39:845-861.