CO-MORBIDITIES IN HEART FAILURE

Basuki Rahmat, MD

RSUD Kota Mataram

Disclaimer
 This material is intended for medical education and information
only.
 This scientific information may include data/information on
investigational uses of compounds/drugs that have not yet been
approved by regulatory authorities (BPOM). Such information is not
intended to be promoting or recommending any indication, dosage
or other claim not covered in the licensed product information.
 COMORBIDITIES in HF
1. Anaemia 11. Liver dysfunction
2. Stroke 12. Gout
3. Angina 13. Hyperlipidemia
4. Asthma & COPD 14. Hypertension
5. Cachexia 15. Kidney dysfunction
6. Cancer 16. Obesity
7. Diabetes 17. Sleep disordered breathing
8. Depression 18. Thyroid dysfunction
9. GI problems 19. Erectile dysfunction
10. Electrolyte imbalance 20. Arrhythmias
Comorbidities and All-cause
mortality

European Journal of Heart Failure (2014) 16, 103–111

Comorbidities and HF
hospitalization

European Journal of Heart Failure (2014) 16, 103–111

The American Journal of Medicine (2011) 124, 136-143
European Journal of Heart Failure (2014) 16, 103–111
Yeung et.al, CMAJ 2012; 184 (14)
WHY IMPORTANT ?
1. Confusing diagnostics
2. May affect the use of treatments for HF
3. May cause worsening HF (incl drugs)
4. Predictors of poor prognosis
5. Drugs interactions
6. Reduce patients adherence
7. Worsen clinical status
8. Limited evidences
CONSEQUENCES COMORBIDITIES IN HF

Increased complexity of management

Risk for future deterioration

Poor Prognosis

Yeung et.al, CMAJ 2012; 184 (14)

ATRIAL FIBRILATION & HF
IMPACT AF IN HF
DIABETES & HF
DIABETES A RISK FACTOR DEVELOPMENT HF
 PATHOPHYSIOLOGY DIABETES IN HF

Dunlay et.al, Type 2 Diabetes Mellitus and Heart Failure, A Scientific Statement From the American Heart Association and Heart Failure Society of America 2019
HF causes Insulin Resistance and Diabetes
ANAEMIA & HF
PATHOPHYSIOLOGY ANAEMIA IN HF
ID MAJOR CONTRIBUTE EXERCISE
INTOLERANCE IN HF
COPD & HF
Trinkmann et.al, Cardiovascular Comorbidities in Chronic
Obstructive Pulmonary Disease (COPD)—Current Considerations
for Clinical Practice, 2018
THYROID & HF
Thyroid and Cardiovascular
function
- The clinical significance -
• Intimately linked
• Known thyroid dysfunction  assess cardiovascular disease/ risk
• Known cardiovascular disease (especially arrhythmia)  assess thyroid
function

SHOULD BE SCREENED !
THYROID AND HF
 Cardiovascular effects on thyroid dysfunction

Variables Hyperthyroidism hypothyroidism

Thyroid hormones > <
Oxidative metabolism > <
Natriuretic peptide > <
Lipids an lipoproteins < >
Heart rate > <
Systemic vascular resistance < >
Cardiac output > <
Cardiac contractility > <

Stanciu, E. et al. Impact of thyroid siease on heart faiure.

In : The Role of Clinical Cardiac Electrophysiology in The Management of Congestive Heart Failure, 2017
HIPONATREMIA & HF
 Lama Rawat Pasien Gagal Jantung PJNHK
Lama Rawat Tahun 2014 (hari) Lama Rawat Tahun 2015 (hari)

Gagal Jantung Gagal Jantung Gagal Jantung Gagal Jantung

Gagal Jantung Gagal Jantung dengan hiponatremia
tanpa tanpa
dengan hiponatremia hiponatremia
hiponatremia
 HypoNa – HF Mortality

Rusinaru D, Tribouilloy C, Berry C, Richards AM, Whalley GA, Earle N, et al. .Eur J Heart Fail. 2012;14(10):1139–46
 HF
CONCLUSION

HF COMORBIDITES DEPRESSION

TYPE A PERSON
ABNORMAL LAB RESULT

INFLAMMATION
BASUKI 2022
 CONCLUSION
• Management of co-morbidities is a key
component of the holistic care of patients
with HF
Thanks you