Clinical Scorecard: Evaluating the Effectiveness of Comprehensive Comorbidity Assessments in Outpatients with Heart Failure and Preserved Ejection Fraction

At a Glance

Key Highlights

• Routine standardized comorbidity screening identified one additional comorbidity per patient on top of a median of three pre-existing conditions.
• Most commonly newly diagnosed comorbidities were sleep apnoea (33%) and iron deficiency (35%).
• Treatment of existing comorbidities such as diabetes, hypercholesterolaemia, and obesity was often suboptimal compared to guideline recommendations.

Guideline-Based Recommendations

Diagnosis

• Use ESC 2016 or 2021 guidelines for HFpEF diagnosis including echocardiography and clinical scoring systems (H2FPEF, HFA-PEFF).
• Routine screening for iron deficiency is recommended (Class 1C).
• Comprehensive comorbidity screening including laboratory tests, sleep apnoea screening, Holter monitoring, spirometry, exercise testing, and 6-minute walk test.

Management

• Implement guideline-directed therapy for comorbidities alongside HF symptom management.
• Use mineralocorticoid receptor antagonists in specific HFpEF subgroups.
• SGLT2 inhibitors are recommended for all HFpEF patients.
• Personalized management targeting comorbidities may improve clinical outcomes.

Monitoring & Follow-up

• Regular assessment of comorbidity status and treatment effectiveness.
• Ongoing evaluation of newly diagnosed comorbidities to optimize management.

Risks

• High comorbidity burden correlates with increased mortality risk in HFpEF.
• Suboptimal treatment of comorbidities may worsen prognosis and increase hospitalization rates.

Patient & Prescribing Data

501 HFpEF outpatients, average age 75, 67% female

Despite high prevalence of comorbidities, many patients received suboptimal treatment for diabetes (23% treated), hypercholesterolaemia (36% treated), and obesity (45% treated), highlighting gaps in guideline adherence.

Clinical Best Practices

• Adopt systematic, routine screening for comorbidities in HFpEF patients to detect undiagnosed conditions.
• Integrate personalized comorbidity management plans alongside HF therapies.
• Ensure adherence to guideline-directed therapies for comorbidities to improve patient outcomes.
• Utilize multidisciplinary approaches including sleep studies and iron status assessments.

References

• ESC 2021 Heart Failure Guidelines
• Editorial Comment on Standardized HFpEF Pathways