Challenges With Initiating New Therapies for Heart Failure

James Januzzi, MD: Gregg, you’ve talked in the past about the complexities of comorbidities. How much of a challenge is this with respect to management of patients with heart failure? How many comorbidities do our patients typically come with?

Gregg C. Fonarow, MD: A lot of comorbidities. But in many ways, things have gotten easier. The medications we’re talking about, which are core and foundational for their heart failure, can help improve some of the comorbid conditions. For example, renal protective effects, potentially sacubitril valsartan and most dramatically with the SGLT2 [sodium-glucose cotransport protein – 2] inhibitors. The added benefit if the patient has type 2 diabetes, as many of our patients do, to be able to improve their glucose control as well as treating their underlying heart failure. There are some complementary aspects, but many patients have lung disease and atrial fibrillation, and there will be additional medications and comorbid conditions that we also need to manage. Depression can be an issue that can then also impact medication adherence. Thus, we need to take a holistic approach to the patient and address all their comorbid conditions, along with their underlying heart failure. These patients are at risk for respiratory infection. Influenza vaccination, pneumococcal vaccination, COVID-19 vaccinations—those are also critically important. That multi–disciplinary team approach is so essential anywhere we’re encountering these patients and not getting in too much of a silo approach: “I’m only managing their heart failure,” or, “I’m only managing their COPD [chronic obstructive pulmonary disease] and not see that bigger picture.”

James Januzzi, MD: Wonderful summary. That really illustrates how we have to be a complete clinician for our patients treating multiple comorbidities. Gregg, you and others have taught me that our patients have an average of 5 comorbidities. Many of them we have to intervene on. Iron deficiency, for example, is 1 that may improve symptoms and quality of life and reduce hospitalization.

This transcript has been edited for clarity.