Non cardiovascular comorbidities in Heart Failure. An updated position paper from the Heart Failure Working Group of the Italian Society of Cardiology (SIC).

Heart Failure (HF) is frequently associated with various non cardiovascular (CV) comorbidities significantly impacting HF prognosis. Indeed, the simultaneous presence of multiple diseases leads to an increased vulnerability, with frailty occurrence. This status implies poor quality of life and increased adverse events rate in terms of hospitalization and mortality. Therefore, the most recent trials and observational studies indicate non-CV comorbidities as new targets for novel management strategies and drugs; however, there is still the need to better understand the pathophysiology of non-CV comorbidities and the possible interplay between non-CV comorbidities and HF. Additionally, metabolic, and multiple organ diseases reduce the use and the achievement of targeted doses of HF Guideline-directed medical therapy (GDMT), due to potential adverse effects, exposing patients to further clinical events. Finally, non-CV comorbidities burden demonstrated different prevalence and prognostic impact according to HF phenotypes, impacting on the disease progression. Therefore, in order to provide physicians and researchers engaged in the "fight against heart failure" an updated practice guide, the Working Group on Heart Failure of the Italian Society of Cardiology (ISC) offers a revised manifesto on the relationship between non-CV comorbidities and HF.