Chronic heart failure as multimorbid state
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Abstract
Regulatory, structural and functional disturbances of other organs and systems (kidney, hepar, vessels, skeletal muscles, brain etc) play the substantial role in CHF. These disturbances may be the conseguences of pre-existing states (hypertension, diabetes, hypo- or hyperthyreoidism etc) and from, other side, may reflect the progressive inherent changes in chronic heart failure (CHF) per se. In particular, currently relevant comorbidities in this syndrome are insulin resistance, diabetes mellitus, renal dysfunction, cognitive impairment, depression peripheral myopathy. Every of them demonstrate the close pathophysiologic interplay with CHF which results in clinical prognosis impairment and in decrease of life quality. Prevalence of renal dysfunction described in 39 % of patients with CHF in our research. Renal dysfunction connected with older age, high class of NYHA, diabetes mellitus, arterial hypertension, higher level of citrulline and uric acid in patients with CHF. Patients with iron deficiency characterized with high class of NYHA, low functionality and poor quality of life. In patients with iron deficiency noted high level of mortality and many critical clinical events. Prevalence of cognitive impairment described in 85 % of patients with CHF in our research. Cognitive dysfunction associated with older age, high class of NYHA, diabetes mellitus, arterial hypertension, bad life quality, high level of ceruloplasmin in patients with CHF. Taking to account above-mentioned comorbidities in quideline-recommended management of CHF and the use of additional therapeutic approaches targeted to its treatment represent the contemporary strategy of personalized treatment in this syndrome.
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