Heart failure and comorbidities

Heart failure is a frequent disease in the elderly. Its clinical presentation is less typical and the prognosis more severe than in younger subjects because heart failure occurs in patients with multiple comorbidities. A comprehensive geriatric assessment should therefore be performed to detect the vulnerabilities and manage the comorbidities. The main diseases associated with heart failure are dementia, depression, malnutrition, atrial fibrillation, coronary artery disease, orthostatic hypotension, renal failure, anemia and iron deficiency. Comorbidities worsen heart failure and makes its treatment more difficult. The identification and treatment of comorbidities improve the prognosis in terms of mortality but especially in terms of quality of life. Caution with drugs is necessary because of pharmacokinetic or pharmacodynamic changes related to aging and the comorbidities. In this context, clinical and laboratory monitoring should be increased, mostly during an acute event (acute heart failure, infection, dehydration, fall, new therapy...). Therefore, the follow-up of elderly patients with heart failure requires a multidisciplinary approach that involves close cooperation between cardiologists, geriatricians, general practitioners, nurses, and pharmacists.