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Heart Failure and Comorbidities—Part 1

  • CARDIOVASCULAR CARE (L ROEVER, SECTION EDITOR)
  • Published:
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Abstract

Purpose of Review

The main objective of the 1st part of this review is to demonstrate that a better understanding of comorbidities such as COPD, obstructive sleep apnea, thyroid dysfunction, cardiorenal syndrome, its pathophysiological and therapeutic implications, impact on the management of FH by interfering with its survival, and quality of life of patients.

Recent Findings

The prevalence of heart failure will increase 46% from 2012 to 2030, resulting in > 8 million people ≥ 18 years of age. This disease has a large burden of noncardiovascular comorbidities, which may increase the risk of mortality and decrease quality of life. There is a perception that patients hospitalized for HF are also becoming more medically complex. In this review, we highlight important comorbidities often found in patients with heart failure.

Summary

Approximately one-third of patients with heart failure also have chronic obstructive pulmonary disease. Obstructive sleep apnea syndrome is a highly prevalent disorder in HF patients, occurring in 46–80% of patients. It is known that changes in thyroid metabolism have been associated as an independent risk factor regarding the progression and development of heart failure (HF). Understanding cardiorenal syndrome facilitates the management of FH.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. •• Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, et al. Heart Disease and Stroke Statistics-2019 Update: a report from the American Heart Association. Circulation. 2019;139(10):e56–e528. https://doi.org/10.1161/CIR.0000000000000659. The most up-to-date statistics related to heart disease, stroke, and the cardiovascular risk factors.

    Article  PubMed  Google Scholar 

  2. Luscher TF. Heart failure: focus on comorbidities, inflammation, and heart rate. Eur Heart J. 2015;36(11):635–7. https://doi.org/10.1093/eurheartj/ehv037.

    Article  PubMed  Google Scholar 

  3. Heidenreich PA, Albert NM, Allen LA, Bluemke DA, Butler J, Fonarow GC, et al. Forecasting the impact of heart failure in the United States: a policy statement from the American Heart Association. Circ Heart Fail. 2013;6(3):606–19. https://doi.org/10.1161/HHF.0b013e318291329a.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  4. Mentz RJ, Kelly JP, von Lueder TG, Voors AA, Lam CS, Cowie MR, et al. Noncardiac comorbidities in heart failure with reduced versus preserved ejection fraction. J Am Coll Cardiol. 2014;64(21):2281–93. https://doi.org/10.1016/j.jacc.2014.08.036.

    Article  PubMed  PubMed Central  Google Scholar 

  5. van Deursen VM, Urso R, Laroche C, Damman K, Dahlstrom U, Tavazzi L, et al. Co-morbidities in patients with heart failure: an analysis of the European heart failure pilot survey. Eur J Heart Fail. 2014;16(1):103–11. https://doi.org/10.1002/ejhf.30.

    Article  PubMed  Google Scholar 

  6. Mascarenhas J, Azevedo A, Bettencourt P. Coexisting chronic obstructive pulmonary disease and heart failure: implications for treatment, course and mortality. Curr Opin Pulm Med. 2010;16(2):106–11. https://doi.org/10.1097/MCP.0b013e328335dc90.

    Article  PubMed  Google Scholar 

  7. Chhabra SK, Gupta M. Coexistent chronic obstructive pulmonary disease-heart failure: mechanisms, diagnostic and therapeutic dilemmas. Indian J Chest Dis Allied Sci. 2010;52(4):225–38.

    PubMed  Google Scholar 

  8. de Groote P, Isnard R, Clerson P, Jondeau G, Galinier M, Assyag P, et al. Improvement in the management of chronic heart failure since the publication of the updated guidelines of the European Society of Cardiology. The Impact-Reco Programme. Eur J Heart Fail. 2009;11(1):85–91. https://doi.org/10.1093/eurjhf/hfn005.

    Article  PubMed  Google Scholar 

  9. Schefold JC, Filippatos G, Hasenfuss G, Anker SD, Von Haehling S. Heart failure and kidney dysfunction: epidemiology, mechanisms and management. Nat Rev Nephrol. 2016;12:610–23. https://doi.org/10.1038/nrneph.2016.113.

    Article  PubMed  CAS  Google Scholar 

  10. • Rangaswami J, Bhalla V, Blair JEA, Chang TI, Costa S, Lentine KL, et al. Cardiorenal syndrome: classification, pathophysiology, diagnosis, and treatment strategies: a scientific statement from the American Heart Association. Circulation. 2019;139:E840–E78. https://doi.org/10.1161/CIR.0000000000000664. Describe the epidemiology and pathogenesis of cardiorenal syndrome in the context of the continuously evolving nature of its clinicopathological description over the past decade.

  11. • Clase CM, Carrero J-J, Ellison DH, Grams ME, Hemmelgarn BR, Jardine MJ, et al. Potassium homeostasis and management of dyskalemia in kidney diseases: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int. 2020;97:42–61. https://doi.org/10.1016/j.kint.2019.09.018. To identify key issues relevant to the optimal prevention, management, and treatment of arrhythmias and their complications in patients with kidney disease.

    Article  PubMed  CAS  Google Scholar 

  12. Matsushita K, Sang Y, Yang C, Ballew SH, Grams ME, Coresh J, et al. Dyskalemia, its patterns, and prognosis among patients with incident heart failure: a nationwide study of US veterans. PLoS One. 2019;14:1–12. https://doi.org/10.1371/journal.pone.0219899.

  13. Linde C, Qin L, Bakhai A, Furuland H, Evans M, Ayoubkhani D, et al. Serum potassium and clinical outcomes in heart failure patients: results of risk calculations in 21 334 patients in the UK. ESC Heart Fail. 2019;6:280–90. https://doi.org/10.1002/ehf2.12402.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Bianchi S, Regolisti G. Pivotal clinical trials, meta-analyses and current guidelines in the treatment of hyperkalemia. Nephrol Dialysis Transplant. 2019;34:iii51–61. https://doi.org/10.1093/ndt/gfz213.

    Article  Google Scholar 

  15. Li L, Harrison SD, Cope MJ, Park C, Lee L, Salaymeh F, et al. Mechanism of action and pharmacology of patiromer, a nonabsorbed cross-linked polymer that lowers serum potassium concentration in patients with hyperkalemia. J Cardiovasc Pharmacol Ther. 2016;21:456–65. https://doi.org/10.1177/1074248416629549.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  16. Pitt B, Anker SD, Bushinsky DA, Kitzman DW, Zannad F, Huang IZ. Evaluation of the efficacy and safety of RLY5016, a polymeric potassium binder, in a double-blind, placebo-controlled study in patients with chronic heart failure (the PEARL-HF) trial. Eur Heart J. 2011;32:820–8. https://doi.org/10.1093/eurheartj/ehq502.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  17. Bakris GL, Pitt B, Weir MR, Freeman MW, Mayo MR, Garza D, et al. Effect of patiromer on serum potassium level in patients with hyperkalemia and diabetic kidney disease the AMETHYST-DN randomized clinical trial. J Am Med Assoc. 2015;314:151–61. https://doi.org/10.1001/jama.2015.7446.

    Article  CAS  Google Scholar 

  18. Weir MR, Bakris GL, Bushinsky DA, Mayo MR, Garza D, Stasiv Y, et al. Patiromer in patients with kidney disease and hyperkalemia receiving RAAS inhibitors. N Engl J Med. 2015;372:211–21. https://doi.org/10.1056/NEJMoa1410853.

    Article  PubMed  CAS  Google Scholar 

  19. NCT03888066 CgI. Patiromer for the management of hyperkalemia in subjects receiving RAASi medications for the treatment of heart failure (DIAMOND). 2020.

  20. Kosiborod M, Rasmussen HS, Lavin P, Qunibi WY, Spinowitz B, Packham D, et al. Effect of sodium zirconium cyclosilicate on potassium lowering for 28 days among outpatients with hyperkalemia: the HARMONIZE randomized clinical trial. J Am Med Assoc. 2014;312:2223–33. https://doi.org/10.1001/jama.2014.15688.

    Article  CAS  Google Scholar 

  21. Roger SD, Spinowitz BS, Lerma EV, Singh B, Packham DK, Al-Shurbaji A, et al. Efficacy and safety of sodium zirconium cyclosilicate for treatment of hyperkalemia: an 11-month open-label extension of HARMONIZE. Am J Nephrol. 2019;50:473–80. https://doi.org/10.1159/000504078.

    Article  PubMed  CAS  Google Scholar 

  22. Yumino DAI, Wang H, Floras JS, Newton GE, Mak S, Ruttanaumpawan P, et al. Prevalence and physiological predictors of sleep apnea in patients with heart failure and systolic dysfunction. 2009;15:279–85. https://doi.org/10.1016/j.cardfail.2008.11.015.

  23. • Borrelli C, Gentile F, Sciarrone P, Mirizzi G, Vergaro G, Ghionzoli N, et al. Central and obstructive apneas in heart failure with reduced, mid-range and preserved ejection fraction. Front Cardiovas Med. 2019;6. https://doi.org/10.3389/fcvm.2019.00125. A comparison of apnea prevalence, predictors and clinical correlates in the whole HF spectrum.

  24. Arzt M, Woehrle H, Oldenburg O, Graml A, Suling A, Erdmann E, et al. Prevalence and predictors of sleep-disordered breathing in patients with stable chronic heart failure: the SchlaHF registry. JACC: Heart Failure. 2016;4:116–25. https://doi.org/10.1016/j.jchf.2015.09.014.

    Article  PubMed  Google Scholar 

  25. Foley RN, Curtis BM, Randell EW, Parfrey PS. Left ventricular hypertrophy in new hemodialysis patients without symptomatic cardiac disease. Clin J Am Soc Nephrol. 2010;5:805–13. https://doi.org/10.2215/CJN.07761109.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  26. • Anker MS, von Haehling S, Landmesser U, Coats AJS, Anker SD. Cancer and heart failure-more than meets the eye: common risk factors and co-morbidities. Eur J Heart Fail. 2018;20(10):1382–4. https://doi.org/10.1002/ejhf.1252. Worldwide more than 32 million patients suffer from cancer, and more than 23 million from heart failure. Estimates for frequency of cardiovascular deaths in 1.2 million cancer patients. Researches in the field of cardio‐oncology has markedly increased in the last few years and are rapidly gaining a better understanding of the underlying mechanisms and possible clinical targets.

  27. Arzt M, Floras JS, Logan AG, Kimoff RJ, Series F, Morrison D, et al. Suppression of central sleep apnea by continuous positive airway pressure and transplant-free survival in heart failure: a post hoc analysis of the Canadian Continuous Positive Airway Pressure for Patients with Central Sleep Apnea and Heart Failure. Trial Circul. 2007;115:3173–80. https://doi.org/10.1161/CIRCULATIONAHA.106.683482.

    Article  Google Scholar 

  28. Gottlieb DJ, Yenokyan G, Newman AB, O'Connor GT, Punjabi NM, Quan SF, et al. Prospective study of obstructive sleep apnea and incident coronary heart disease and heart failure: the sleep heart health study. Circulation. 2010;122:352–60. https://doi.org/10.1161/CIRCULATIONAHA.109.901801.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Gupta A, Quan SF, Oldenburg O, Malhotra A, Sharma S. Sleep-disordered breathing in hospitalized patients with congestive heart failure: a concise review and proposed algorithm. Heart Fail Rev. 2018;23:701–9. https://doi.org/10.1007/s10741-018-9715-y.

    Article  PubMed  PubMed Central  Google Scholar 

  30. • Yoshihisa A, Takeishi Y. Heart failure and sleep disordered breathing. J Med Sci. 2017. This review explores emerging data on the cost effectiveness and outcome of early intervention with PAP in hospitalized CHF patients.

  31. Sin DD, Logan AG, Fitzgerald FS, Liu PP, Bradley TD. Effects of continuous positive airway pressure on cardiovascular outcomes in heart failure patients with and without Cheyne-Stokes respiration. Circulation. 2000;102:61–6. https://doi.org/10.1161/01.CIR.102.1.61.

    Article  PubMed  CAS  Google Scholar 

  32. Khayat R, Jarjoura D, Porter K, Sow A, Wannemacher J, Dohar R, et al. Sleep disordered breathing and post-discharge mortality in patients with acute heart failure. Eur Heart J. 2015;36:1463–9. https://doi.org/10.1093/eurheartj/ehu522.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Mechanisms of reduced sleepiness symptoms in heart failure and obstructive sleep apnea, (2019).

  34. Emdin M, Mirizzi G, Giannoni A, Poletti R, Iudice G, Bramanti F et al., editors. Prognostic significance of central apneas throughout a 24-hour period in patients with heart failure 2017.

  35. Daubert MA, Whellan DJ, Woehrle H, Tasissa G, Anstrom KJ, Lindenfeld JA, et al. Treatment of sleep-disordered breathing in heart failure impacts cardiac remodeling: insights from the CAT-HF Trial. Am Heart J. 2018;201:40–8. https://doi.org/10.1016/j.ahj.2018.03.026.

    Article  PubMed  Google Scholar 

  36. Cowie MR, Gallagher AM, editors. Sleep disordered breathing and heart failure what does the future hold? 2017.

    Google Scholar 

  37. • Seferovic PM, Ponikowski P, Anker SD, Bauersachs J, Chioncel O, Cleland JGF, et al. Clinical practice update on heart failure 2019: pharmacotherapy, procedures, devices and patient management. In: An expert consensus meeting report of the Heart Failure Association of the European Society of Cardiology. New York: John Wiley and Sons Ltd; 2019. The report describes how these guidance statements are supported by evidence, it makes some practical comments, and it highlights new research areas and how progress might change the clinical management of HF.

  38. Design of the effect of adaptive servo-ventilation on survival and cardiovascular hospital admissions in patients with heart failure and sleep apnoea: the ADVENT-HF trial, (2017).

  39. Abraham WT, Jagielski D, Oldenburg O, Augostini R, Krueger S, Kolodziej A, et al. Phrenic nerve stimulation for the treatment of central sleep apnea. JACC: Heart Failure. 2015;3:360–9. https://doi.org/10.1016/j.jchf.2014.12.013.

    Article  PubMed  Google Scholar 

  40. Costanzo MR, Ponikowski P, Javaheri S, Augostini R, Goldberg L, Holcomb R, et al. Transvenous neurostimulation for central sleep apnoea: a randomised controlled trial. Lancet. 2016;388:974–82. https://doi.org/10.1016/S0140-6736(16)30961-8.

    Article  PubMed  Google Scholar 

  41. Fox H, Oldenburg O, Javaheri S, Ponikowski P, Augostini R, Goldberg LR, et al. Long-term efficacy and safety of phrenic nerve stimulation for the treatment of central sleep apnea. Sleep. 2019;42:1–9. https://doi.org/10.1093/sleep/zsz158.

    Article  Google Scholar 

  42. Thyroid hormone and heart failure, (2006).

  43. Kannan L, Shaw PA, Morley MP, Brandimarto J, Fang JC, Sweitzer NK, et al. Thyroid dysfunction in heart failure and cardiovascular outcomes. Circ Heart Fail. 2018;11:e005266. https://doi.org/10.1161/CIRCHEARTFAILURE.118.005266.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  44. Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC), (2010).

  45. Siu CW, Jim MH, Zhang X, Chan YH, Pong V, Kwok J, et al. Comparison of atrial fibrillation recurrence rates after successful electrical cardioversion in patients with hyperthyroidism-induced versus non-hyperthyroidism-induced persistent atrial fibrillation. Am J Cardiol. 2009;103:540–3. https://doi.org/10.1016/j.amjcard.2008.10.019.

    Article  PubMed  Google Scholar 

  46. Mechanisms in endocrinology: heart failure and thyroid dysfunction., (2012).

  47. Moruzzi P, Doria E, Agostoni PG. Medium-term effectiveness of L-thyroxine treatment in idiopathic dilated cardiomyopathy. Am J Med. 1996;101:461–7. https://doi.org/10.1016/s0002-9343(96)00281-1.

    Article  PubMed  CAS  Google Scholar 

  48. Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG, et al. Focused update: ACCF/AHA guidelines for the diagnosis and management of heart failure in adults. Circulation. 2009;119:1977–2016. https://doi.org/10.1161/CIRCULATIONAHA.109.192064.

    Article  PubMed  Google Scholar 

  49. Alagiakrishnan K, Mah D, Ahmed A, Ezekowitz J. Cognitive decline in heart failure. Heart Fail Rev. 2016;21(6):661–73. https://doi.org/10.1007/s10741-016-9568-1.

    Article  PubMed  CAS  Google Scholar 

  50. Cameron J, Gallagher R, Pressler SJ. Detecting and managing cognitive impairment to improve engagement in heart failure self-care. Curr Heart Fail Rep. 2017;14(1):13–22. https://doi.org/10.1007/s11897-017-0317-0.

    Article  PubMed  Google Scholar 

  51. Agarwal KS, Kazim R, Xu J, Borson S, Taffet GE. Unrecognized cognitive impairment and its effect on heart failure readmissions of elderly adults. J Am Geriatr Soc. 2016;64(11):2296–301. https://doi.org/10.1111/jgs.14471.

    Article  PubMed  Google Scholar 

  52. van der Wal HH, van Deursen VM, van der Meer P, Voors AA. Comorbidities in heart failure. Handbook of experimental pharmacology: Springer New York LLC; 2017. p. 35–66.

  53. Cuomo A, Rodolico A, Galdieri A, Russo M, Campi G, Franco R, et al. Heart failure and cancer: mechanisms of old and new cardiotoxic drugs in cancer patients. Card Fail Rev. 2019;5(2):112–8. https://doi.org/10.15420/cfr.2018.32.2.

    Article  PubMed  PubMed Central  Google Scholar 

  54. • Bertero E, Ameri P, Maack C. Bidirectional relationship between cancer and heart failure: old and new issues in cardio-oncology. Card Fail Rev. 2019;5(2):106–11. https://doi.org/10.15420/cfr.2019.1.2. It has been proposed that HF might represent an oncogenic condition. This hypothesis is supported by preclinical studies demonstrating that hyperactivation of the sympathetic nervous system and renin–angiotensin–aldosterone system, which is a hallmark of HF, promotes cancer growth and dissemination.

  55. Banke A, Schou M, Videbaek L, Moller JE, Torp-Pedersen C, Gustafsson F, et al. Incidence of cancer in patients with chronic heart failure: a long-term follow-up study. Eur J Heart Fail. 2016;18(3):260–6. https://doi.org/10.1002/ejhf.472.

    Article  PubMed  Google Scholar 

  56. Hasin T, Gerber Y, Weston SA, Jiang R, Killian JM, Manemann SM, et al. Heart failure after myocardial infarction is associated with increased risk of cancer. J Am Coll Cardiol. 2016;68(3):265–71. https://doi.org/10.1016/j.jacc.2016.04.053.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Levis BE, Binkley PF, Shapiro CL. Cardiotoxic effects of anthracycline-based therapy: what is the evidence and what are the potential harms? Lancet Oncol. 2017;18(8):e445–e56. https://doi.org/10.1016/S1470-2045(17)30535-1.

    Article  PubMed  CAS  Google Scholar 

  58. Snipelisky D, Park JY, Lerman A, Mulvagh S, Lin G, Pereira N, et al. How to develop a cardio-oncology clinic. Heart Fail Clin. 2017;13(2):347–59. https://doi.org/10.1016/j.hfc.2016.12.011.

    Article  PubMed  Google Scholar 

  59. Totzeck M, Mincu RI, Heusch G, Rassaf T. Heart failure from cancer therapy: can we prevent it? ESC Heart Fail. 2019;6(4):856–62. https://doi.org/10.1002/ehf2.12493.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Bertero E, Canepa M, Maack C, Ameri P. Linking heart failure to Cancer. Circulation. 2018;138(7):735–42. https://doi.org/10.1161/CIRCULATIONAHA.118.033603.

    Article  PubMed  Google Scholar 

  61. Canli O, Nicolas AM, Gupta J, Finkelmeier F, Goncharova O, Pesic M, et al. Myeloid cell-derived reactive oxygen species induce epithelial mutagenesis. Cancer Cell. 2017;32(6):869–83 e5. https://doi.org/10.1016/j.ccell.2017.11.004.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Medical School of Federal University of Bahia - UFBA/FAMEB, Salvador, Bahia, Brazil

    Andre Rodrigues Duraes, Yasmin de Souza Lima Bitar & Mansueto Gomes Neto

  2. Hospital Geral Roberto Santos, Diretoria Médica, Salvador, Bahia, Brazil

    Andre Rodrigues Duraes

  3. Cardiology Service, Hans Dieter Schmidt Regional Hospital, Joinville, Santa Catarina, Brazil

    Conrado Roberto Hoffmann Filho

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Duraes, A.R., Filho, C.R.H., de Souza Lima Bitar, Y. et al. Heart Failure and Comorbidities—Part 1. Curr Emerg Hosp Med Rep 8, 60–68 (2020). https://doi.org/10.1007/s40138-020-00210-9

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