Comorbid Conditions in Heart Failure: An Unhappy Marriage

The general issue of comorbidity is of major clinical importance for patients, health care providers, and society as a whole. A principal manifestation of aging, multimorbidity poses many challenges on the overall health of an individual and to the health care system in heart failure. Polypharmacy in heart failure patients with multiple morbidities influences their prognosis, adds a disease burden, and challenges adherence to medical management while increasing overall cost of care. Heart failure has special bidirectional relationships with cardiac and noncardiac comorbidity that are pathophysiologically intertwined. Examples of such intertwined comorbidities include arrhythmias, valvular disease, renal dysfunction, pulmonary dysfunction (both obstructive and restrictive pulmonary physiology), pulmonary hypertension, sleep apnea, liver dysfunction, diabetes mellitus, anemia, stroke, and skeletal myopathy. Such limitations are not just in the physical domain; mental diseases such as depression can also perpetuate a negative self-fulfilling cycle of clinical decline in heart failure. Beyond the direct organ system interactions and their confounding factors, more insight is now being developed to appreciate common system pathophysiologic mechanisms like inflammation and oxidative stress that are operative in a unifying manner to influence the partnership of disease-disease interaction.
Source: Heart Failure Clinics - Category: Cardiology Authors: Source Type: research