An increasing number of patients are diagnosed with heart failure. The symptoms of heart failure are  dyspnea, exercise limitation, decline in quality of life, recurrent hospitalizations and premature mortality. Heart failure is therefore an increasing challenge for the future.

Heart failure is a clinical syndrome caused by myocardial dysfunction, which reduces cardiac output and/or increases pressure in the left ventricle (LV). This leads to congestion. Salt and fluid retention occurs due to upregulation of the renin-angiotensin-aldosterone system (RAAS) and the sympathetic nervous system and dysfunction of the natriuretic peptide system, especially in HFrEF. This causes shortness of breath due to pulmonary congestion and signs of excessive fluid retention and venous congestion: pitting edema of the lower limbs and/or ascites.

Heart failure is usually a chronic disease. See Figure. The course of the disease is characterized by periods of stable clinical status or chronic heart failure and periods of increase in heart failure symptoms (cardiac decompensation, acute heart failure). The aim is to achieve the best possible symptom control, preferably without fluid retention (euvolemia) and with stable vital parameters (weight, blood pressure and heart rate). Numerous factors or triggers can disrupt this balance and lead to an increase in intracardiac pressure and/or fluid retention (heart decompensation or acute heart failure), with or without the need for hospital admission. Hospitalizations due to heart failure are often long (average 8 to 10 days in the recent ADVOR trial) and are responsible for the largest cost in the total heart failure care budget.

Acute cardiac decompensation is manifested by changes in symptoms, weight, blood pressure and/or heart rate. Monitoring these parameters at home and timely detection of changes in these parameters can lead to timely adjustments to therapy, which can sometimes prevent further deterioration and hospital admissions.

Without proper treatment, the prognosis for patients with heart failure is often poor due to progressive deterioration of cardiac function with episodes of increased dyspnea and fluid retention (cardiac decompensation), arrhythmias and general deterioration with multi-organ involvement (renal insufficiency, liver cirrhosis and ascites, deconditioning, cardiac cachexia, etc.). This leads to loss of functionality and quality of life, repeated hospital admissions (and high costs to society) and mortality.

Patients with heart failure often have one or more comorbidities, on average 4 per patient. The most
frequent are: coronary artery disease, atrial fibrillation, arterial hypertension, diabetes mellitus, iron deficiency and anemia, renal insufficiency and electrolyte disorders, hyperuricemia and gout, COPD, hepatic and gastrointestinal dysfunction, cachexia and deconditioning, sleep apnea and depression.

These comorbidities are very important because they:

• Can make the diagnosis of heart failure more difficult (e.g. COPD).
• Can worsen the symptoms and severity of heart failure and reduce quality of life.
• Can be the cause of hospital admissions and readmissions.
• May require dose reduction of heart failure medication.
• May require medication that counteracts heart failure therapy or can even worsen heart failure symptoms (e.g. NSAIDs).

Tackling these comorbidities is therefore also very important, together with the optimal treatment of heart failure.