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,United States
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.
