Table 16

Common Cardiac and Noncardiac Comorbidities Encountered in Patients With HFrEF

ComorbidityAssociation With Heart Failure OutcomesClinical Trial Evidence for Modulating ComorbiditySuggested Action
Cardiovascular
Coronary Artery DiseaseStrongStrongEvaluate and revascularize in appropriate patients
Atrial Fibrillation/FlutterStrongIntermediateTreat according to current ACC/AHA/HRS Guideline for the Management of Patients with Atrial Fibrillation (94)
Mitral RegurgitationStrongIntermediateRefer to structural heart disease expert & treat according to current AHA/ACC Guideline for the Management of Patients with Valvular Heart Disease (95)
Aortic StenosisStrongStrongRefer to structural heart disease expert & treat according to current AHA/ACC Guideline for the Management of Patients with Valvular Heart Disease (95)
HypertensionUncertainStrong for preventionTreat according to current ACC/AHA hypertension guidelines
DyslipidemiaUncertainStrong for preventionTreat according to ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults (96). Also see the nonstatin treatment of dyslipidemia clinical pathways (97)
Peripheral Vascular DiseaseModerateNoneTreat according to current AHA/ACC vascular guidelines (98)
Cerebrovascular DiseaseModerateWeakTreat according to current AHA stroke guidelines (99)
Noncardiovascular
ObesityModerate (inverse association)WeakFurther data needed
Chronic Lung DiseaseStrongWeakOptimize therapy, consider pulmonary consultation
Diabetes MellitusStrongIntermediateOptimize therapy, consider SGLT2 inhibitors, consider endocrine consult and follow current American Diabetes Association Standards of Medical Care in Diabetes (100)
Chronic Renal DiseaseStrongWeakOptimize RAASi therapy, consider nephrology consult
AnemiaModerateWeakEvaluate secondary causes, consider transfusing in severe cases
Iron DeficiencyStrongIntermediateConsider intravenous iron replacement for symptom improvement
Thyroid Disorder—hypo or hyperStrongWeakConsider referral to endocrinologist and/or treatment
Sleep Disordered BreathingStrongIntermediateConsider sleep study and treat severe obstructive sleep apnea to improve sleep quality, consider referring to sleep specialist

ACC = American College of Cardiology; AHA = American Heart Association; HRS = Heart Rhythm Society; RAASi = renin-angiotensin-aldosterone system inhibitor; SGLT2 = sodium-glucose co-transporter 2.