Management of Co-Morbidity in Heart Failure

Heart failure (HF) represents one of the major public health problems faced by healthcare systems worldwide, and continues to grow largely because of the increasing age of the population. HF is the leading diagnosis at hospital discharge for patients 65 years or older, accounting for more than 600,000 Medicare hospital discharges in 19961. Among the more than 1 million patients hospitalized annually for HF in the USA, more than 80% are 65 years or older, and more than 50% are 75 years or older2. The cost of managing HF is increasing mainly as a consequence of frequent and prolonged hospitalization.In most patients, and particularly in elderly patients, HF is accompanied by a range of comorbidities that play an integral role in its progression and response to treatment. Comorbidity is defined as a chronic condition that coexists in an individual with another condition that is being described. A distinction is made between noncardiac comorbidities and cardiac conditions that are directly related to the presence of HF such as arrhythmias as well as conditions that predate and contribute to its etiology such as hypertension, diabetes mellitus, and hyperlipidemia. In this chapter, we will focus on noncardiac comorbidities discussing initially the overall problem of comorbidity in HF. The second section will examine specific comorbidities and how best to manage HF in these patients. The final section will consider the problem of polypharmacy when managing patients with comorbidities