Korean Circulation Journal

The Korean Society of Cardiology (대한심장학회)
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Korean Society of Heart Failure Guidelines for the Management of Heart Failure: Management of the Underlying Etiologies and Comorbidities of Heart Failure

  • Sang Min Park (Division of Cardiology, Nowon Eulji Medical Center, Eulji University School of Medicine) ;
  • Soo Youn Lee (Department of Cardiology, Cardiovascular Center, Incheon Sejong Hospital) ;
  • Mi-Hyang Jung (Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea) ;
  • Jong-Chan Youn (Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea) ;
  • Darae Kim (Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Jae Yeong Cho (Department of Cardiovascular Medicine, Chonnam National University Medical School) ;
  • Dong-Hyuk Cho (Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University Medicine) ;
  • Junho Hyun (Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Hyun-Jai Cho (Department of Internal Medicine, Seoul National University Hospital) ;
  • Seong-Mi Park (Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University Medicine) ;
  • Jin-Oh Choi (Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Wook-Jin Chung (Division of Cardiology, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine) ;
  • Seok-Min Kang (Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine) ;
  • Byung-Su Yoo (Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine) ;
  • Committee of Clinical Practice Guidelines, Korean Society of Heart Failure (Korean Society of Heart Failure)
  • Received : 2023.03.20
  • Accepted : 2023.07.11
  • Published : 2023.07.01
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Abstract

Most patients with heart failure (HF) have multiple comorbidities, which impact their quality of life, aggravate HF, and increase mortality. Cardiovascular comorbidities include systemic and pulmonary hypertension, ischemic and valvular heart diseases, and atrial fibrillation. Non-cardiovascular comorbidities include diabetes mellitus (DM), chronic kidney and pulmonary diseases, iron deficiency and anemia, and sleep apnea. In patients with HF with hypertension and left ventricular hypertrophy, renin-angiotensin system inhibitors combined with calcium channel blockers and/or diuretics is an effective treatment regimen. Measurement of pulmonary vascular resistance via right heart catheterization is recommended for patients with HF considered suitable for implantation of mechanical circulatory support devices or as heart transplantation candidates. Coronary angiography remains the gold standard for the diagnosis and reperfusion in patients with HF and angina pectoris refractory to antianginal medications. In patients with HF and atrial fibrillation, longterm anticoagulants are recommended according to the CHA2DS2-VASc scores. Valvular heart diseases should be treated medically and/or surgically. In patients with HF and DM, metformin is relatively safer; thiazolidinediones cause fluid retention and should be avoided in patients with HF and dyspnea. In renal insufficiency, both volume status and cardiac performance are important for therapy guidance. In patients with HF and pulmonary disease, beta-blockers are underused, which may be related to increased mortality. In patients with HF and anemia, iron supplementation can help improve symptoms. In obstructive sleep apnea, continuous positive airway pressure therapy helps avoid severe nocturnal hypoxia. Appropriate management of comorbidities is important for improving clinical outcomes in patients with HF.

Keywords

Acknowledgement

This article has been published jointly, with consent, in both Korean Circulation Journal and International Journal of Heart Failure. Also, the final version of this guideline was endorsed by Korean Society of Cardiology, Korean Society of Lipid and Atherosclerosis, Korean Association of Clinical Cardiology, Korean Society of Hypertension, Korean Society of Heart Failure, Korean Society of Echocardiography, Korean Society of Interventional Cardiology, Korean Heart Rhythm Society, and Korean Society of CardioMetabolic Syndrome.

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