Medizinische Klinik mit Schwerpunkt Kardiologie, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum (CVK), Augustenburger Platz 1, 13353, Berlin, Germany.
Standort Berlin, DZHK (Deutsches Zentrum für Herz-Kreislauf-Forschung), Berlin, Germany.
Herz. 2022 Aug;47(4):301-307. doi: 10.1007/s00059-022-05123-9. Epub 2022 Jun 8.
Chronic heart failure is one of the most common causes of hospitalization and death in industrialized countries. Demographic changes with an aging population are expected to further increase the prevalence of chronic heart failure. The associated increase in comorbidities in patients with chronic heart failure leads to a less favorable prognosis for survival. A selection of the major comorbidities discussed in this review-along with prevalence, impact on prognosis, treatment approaches, and current study status-include atrial fibrillation, arterial hypertension, coronary artery disease, coronary microvascular dysfunction, renal dysfunction, type 2 diabetes, sleep apnea, reduced lymphatic reserve, and the effects on oxygen utilization and physical activity. The complex clinical picture of heart failure with preserved ejection fraction (HFpEF) remains challenging in the nearly absence of evidence-based therapy. Except for comorbidity-specific guidelines, no HFpEF-specific treatment of comorbidities can be recommended at this time. Optimized care is becoming increasingly relevant to reducing hospitalizations through a seamless inpatient and outpatient care structure. Current treatment is focused on symptom relief and management of associated comorbidities. Therefore, prevention through early minimization of risk factors currently remains the best approach.
慢性心力衰竭是工业化国家住院和死亡的最常见原因之一。预计人口老龄化带来的人口结构变化将进一步增加慢性心力衰竭的患病率。慢性心力衰竭患者合并症的增加导致其生存预后较差。本综述讨论了一些主要的合并症——包括患病率、对预后的影响、治疗方法和当前的研究状况——如心房颤动、动脉高血压、冠状动脉疾病、冠状动脉微血管功能障碍、肾功能障碍、2 型糖尿病、睡眠呼吸暂停、淋巴储备减少，以及对氧气利用和体力活动的影响。射血分数保留的心力衰竭（HFpEF）的复杂临床情况在几乎没有循证治疗的情况下仍然具有挑战性。除了特定于合并症的指南外，目前不能推荐针对 HFpEF 特定的合并症的治疗方法。通过无缝的住院和门诊护理结构来优化护理，对于减少住院治疗变得越来越重要。目前的治疗重点是缓解症状和管理相关合并症。因此，通过早期最大限度地减少风险因素来预防仍然是最好的方法。
