Most
patients with
heart failure (HF) have multiple comorbidities, which impact their
quality of life , aggravate HF, and increase
mortality . Cardiovascular comorbidities include systemic and
pulmonary hypertension , ischemic and
valvular heart diseases , and
atrial fibrillation . Non-cardiovascular comorbidities include
diabetes mellitus (DM), chronic
kidney and
pulmonary diseases ,
iron deficiency and
anemia , and
sleep apnea . In
patients with HF with
hypertension and
left ventricular hypertrophy ,
renin-angiotensin system inhibitors combined with
calcium channel blockers and/or
diuretics is an effective
treatment regimen. Measurement of
pulmonary vascular resistance via right
heart catheterization is recommended for
patients with HF considered suitable for implantation of mechanical circulatory support
devices or as
heart transplantation candidates.
Coronary angiography remains the
gold standard for the
diagnosis and
reperfusion in
patients with HF and
angina pectoris refractory to antianginal medications. In
patients with HF and
atrial fibrillation , longterm
anticoagulants are recommended according to the CHA 2 DS 2 -VASc scores.
Valvular heart diseases should be treated medically and/or surgically. In
patients with HF and DM,
metformin is relatively safer;
thiazolidinediones cause fluid retention and should be avoided in
patients with HF and
dyspnea . In
renal insufficiency , both volume status and cardiac performance are important for
therapy guidance. In
patients with HF and
pulmonary disease , beta-blockers are underused, which may be related to increased
mortality . In
patients with HF and
anemia ,
iron supplementation can help improve symptoms. In
obstructive sleep apnea ,
continuous positive airway pressure therapy helps avoid severe nocturnal
hypoxia . Appropriate management of comorbidities is important for improving clinical outcomes in
patients with HF.