Managing Comorbidities in Patients With Chronic Heart Failure

First, Do No Harm

Beth DeJongh; Kade Birkeland; Michael Brenner


Am J Cardiovasc Drugs. 2015;15(3):171-184. 

In This Article

Abstract and Introduction


Heart failure (HF) affects approximately 5.1 million adults in the USA, with expectations of a rise to nearly 8 million adults by 2030. Patients with HF are at increased risk for morbidity/mortality, and comorbidities can further complicate care for these patients. Diabetes mellitus, chronic pain, arrhythmias, and depression are diagnoses that often coexist with HF. Medications commonly used to treat these comorbidities may induce or worsen HF symptoms, so determining appropriate drug therapy is important. Healthcare providers must understand the relationship between these medications and HF in order to improve prescribing practices to increase patient safety and reduce morbidity and mortality. This manuscript discusses the association between certain medications used to treat the aforementioned diagnoses and their relationship to HF. The purpose of this article is to provide guidance on which pharmacologic options require special consideration, increased monitoring, or complete avoidance in HF patients with diabetes mellitus, chronic pain, arrhythmias, and/or depression.


Heart failure (HF) affects approximately 5.1 million adults in the USA, with expectations of a rise to nearly 8 million adults by 2030. The incidence increases to 10 per 1000 in patients aged ≥65 years. Mortality rates for HF have improved, but remain high, with a survival rate of approximately 50 % within 5 years of diagnosis. One in nine deaths mentions HF on the death certificate. In 2012, HF costs were estimated at $US30.7 billion in the USA and could rise to $US69.7 billion by 2030.[1]

Comorbidities often accompany HF, with increasing prevalence in elderly patients. Cardiac and non-cardiac comorbidities can complicate HF care and increase mortality and hospitalization rates.[2,3] A US study from the National Heart Failure Project reviewed 34,587 charts for Medicare patients aged >65 years who were hospitalized with HF. Approximately 38 % of the patients had diabetes and 30 % had atrial fibrillation (AF).[4] In addition, treating diverse disease states increases polypharmacy, exposing patients to increased risk of adverse drug reactions and drug–drug interactions. Additionally, many commonly used medications should be avoided in HF to minimize harm to the patient.

Included in this review are diabetes mellitus, chronic pain, arrhythmias, and depression, which are common diagnoses frequently co-existing in patients with HF. Treating these conditions adds to the complexity of medication management and can be problematic in HF. This review will give guidance as to which therapeutic options should be avoided or closely monitored to reduce risk and therefore imply preferred options.