Title:Common Comorbidities that Alter Heart Failure Prognosis - Shaping New Thinking for Practice

VOLUME: 17 ISSUE: 5

Author(s):Pupalan Iyngkaran*, Merlin Thomas, John D Horowitz, Paul Komesaroff, Michael Jelinek and David L Hare

Affiliation:Department of Cardiology, Heart West Institute, Werribee Mercy Sub School, School of Medicine, Notre Dame University, Notre Dame, IN 46556, Department of Biochemistry, Biochemistry of Diabetes Complications, Monash University, Melbourne, Department of Cardiology, University of Adelaide, Adelaid, Department of Endocrinology, Monash University, Melbourne, Department of Cardiology, University of Melbourne, St. Vincent's Hospital, Melbourne, Department of Cardiology, Cardiovascular Research, University of Melbourne, Austin Health, Melbourne, Victoria

Keywords:Comorbidity, congestive heart failure, disease management, process of care, performance markers, specialist training, obesity, metabolically healthy obesity, obesity paradox, cardiovascular disease, cardiometabolic syndrome.

Abstract:At least half of all heart failure (CHF) patients will have a comorbidity that could be undertreated, requires additional speciality input and/or polypharmacy. These patients are then at risk of iatrogenic and disease-related complications and readmissions if not closely supervised. Common comorbidities of relevance are cardiorenal and cardiometabolic syndromes (DM, obesity, OSA), chronic airways disease, elderly age, and accompanying pharmacotherapies. The structure of community practice often leaves primary, speciality, and allied health care in silos. For example, cardiology speciality training in Australia creates excellent sub-specialists to deliver diagnostic and therapeutic advances. A casualty of this process has been the gradual alienation of general cardiology toward general internal medical specialists and primary care practitioners. The consequences are largely noticed in community practice. The issue is compounded by suboptimal communication of information. This review explores these issues from a cardiology sub-speciality lens; firstly cross speciality areas that are important for cardiologists to maintain their skill, and finally, to obtain a brief overview of disease management and identify game-changing common denominators such as endothelial dysfunction and self-management.