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Vol. 216. Issue 6.
Pages 323-330 (August - September 2016)
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Vol. 216. Issue 6.
Pages 323-330 (August - September 2016)
Symposium. Heart Failure
Comprehensive therapeutic approach for patients with heart failure and comorbidity
Abordaje terapéutico integral del paciente con insuficiencia cardiaca y comorbilidad
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F.J. Ruiz-Laiglesiaa,
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fruizl@unizar.es

Corresponding author.
, V. Garcés-Hornaa, F. Formigab
a Servicio de Medicina Interna, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
b Departamento de Medicina Interna, Hospital Universitario de Bellvitge, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
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Table 1. Comorbidity in patients with heart failure according to data from the Spanish National Heart Failure Registry (RICA).
Abstract

The prevalence of heart failure increases with age and is accompanied by other diseases, which are encompassed within a «cardiometabolic phenotype». Their interrelation changes the evolution and treatment that each disease would have in isolation. Patients with heart failure and comorbidity are frail and complex. They require a comprehensive assessment (not just biomedical), which includes functional, cognitive, affective and psychosocial aspects. The overall treatment, which is not covered in the clinical practice guidelines, should adapt to each and every one of the comorbidities. Polypharmacy should be avoided as much as possible, due to its interactions and reduced adherence. Treatment needs to be optimized and adapted to the evolutionary phase of the disease and the specific needs of each patient. The complexity of the care process for patients with heart failure and comorbidities requires the coordination of healthcare providers and support from family and others involved in the patient's care.

Keywords:
Heart failure
Comorbidity
Treatment
Resumen

La prevalencia de insuficiencia cardiaca aumenta con la edad y se acompaña de otras enfermedades, englobadas en un «fenotipo cardiometabólico». Su interrelación modifica la evolución y tratamiento que cada una tendría aisladamente. El paciente con insuficiencia cardiaca y comorbilidad es un enfermo frágil y complejo. Precisa una valoración integral, no solo biomédica, que incluya aspectos funcionales, cognitivos, afectivos y psicosociales. El tratamiento global, no recogido en las guías de práctica clínica, ha de adaptarse a todas y cada unas de las comorbilidades. Debe evitarse, en lo posible, la polifarmacia, por sus interacciones y la disminución de adherencia. Es necesario optimizar y adaptar el tratamiento a la fase evolutiva de la enfermedad y las necesidades específicas de cada paciente. La complejidad del proceso asistencial del paciente con insuficiencia cardiaca y comorbilidades exige la coordinación de los proveedores de salud, el apoyo familiar y del entorno.

Palabras clave:
Insuficiencia cardíaca
Comorbilidad
Tratamiento

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