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Circulation. 2022;145:e895–e1032. DOI: 10.1161/CIR.0000000000001063 May 3, 2022 e969 CLINICAL STATEMENTS AND GUIDELINES discharge is a desired goal. Although historically this has been an in-person visit, telemedicine is being increasingly used for chronic management. A pragmatic randomized trial found that an initial telephone visit with a nurse or pharmacist to guide follow-up may reduce the need for in-person visits if they are constrained.22 Overall, the timing and method of delivery (in-person clinic versus virtual visit by video or telephone) should be individualized based on patient risk and available care delivery options. Clinical risk prediction tools may help to identify patients at highest risk of postdischarge adverse outcomes.23–25 10 COMORBIDITIES IN PATIENTS WITH HF 10.1 Management of Comorbidities in Patients With HF Recommendations for the Management of Comorbidities in Patients With HF Referenced studies that support the recommendations are summarized in the Online Data Supplements. COR LOE Recommendations Management of Anemia or Iron Deficiency 2a B-R 1. In patients with HFrEF and iron deficiency with or without anemia, intravenous iron replacement is reasonable to improve functional status and QOL.1–4 3: Harm B-R 2. In patients with HF and anemia, erythropoietinstimulating agents should not be used to improve morbidity and mortality.5,6 Management of Hypertension 1 C-LD 3. In patients with HFrEF and hypertension, uptitration of GDMT to the maximally tolerated target dose is recommended.7,8 Management of Sleep Disorders 2a C-LD 4. In patients with HF and suspicion of sleep-disordered breathing, a formal sleep assessment is reasonable to confirm the diagnosis and differentiate between obstructive and central sleep apnea.9,10 2a B-R 5. In patients with HF and obstructive sleep apnea, continuous positive airway pressure may be reasonable to improve sleep quality and decrease daytime sleepiness.9,11–13 3: Harm B-R 6. In patients with NYHA class II to IV HFrEF and central sleep apnea, adaptive servo-ventilation causes harm.11,12 Management of Diabetes 1 A 7. In patients with HF and type 2 diabetes, the use of SGLT2i is recommended for the management of hyperglycemia and to reduce HFrelated morbidity and mortality.14–17 Synopsis Multimorbidity is common in patients with HF, with >85% of patients having ≥2 additional chronic conditions.18,19 Hypertension, ischemic heart disease, diabetes, anemia, CKD, morbid obesity, frailty, and malnutrition are among the most common comorbid conditions in patients with HF (Table 26). These chronic conditions complicate the management of HF and have a significant impact on its prognosis. How to generate specific recommendations addressing many of these conditions in the setting of HF is challenging given the current state of the evidence. For example, although depression is common in patients with HF and strongly impacts QOL and mortality, conventional therapies such as antidepressants have not been effective in Table 26. Most Common Co-Occurring Chronic Conditions Among Medicare Beneficiaries With HF (N=4 947 918), 2011 Beneficiaries Age ≥65 y (n=4 376 150)* Beneficiaries Age <65 y (n=571 768)† n % n % Hypertension 3 685 373 84.2 Hypertension 461 235 80.7 Ischemic heart disease 3 145 718 71.9 Ischemic heart disease 365 889 64.0 Hyperlipidemia 2 623 601 60.0 Diabetes 338 687 59.2 Anemia 2 200 674 50.3 Hyperlipidemia 325 498 56.9 Diabetes 2 027 875 46.3 Anemia 284 102 49.7 Arthritis 1 901 447 43.5 CKD 257 015 45.0 CKD 1 851 812 42.3 Depression 207 082 36.2 COPD 1 311 118 30.0 Arthritis 201 964 35.3 AF 1 247 748 28.5 COPD 191 016 33.4 Alzheimer’s disease or dementia 1 207 704 27.6 Asthma 88 816 15.5 Data source: Centers for Medicare & Medicaid Services administrative claims data, January 2011 to December 2011, from the Chronic Condition Warehouse (CCW), ccwdata.org.50 AF indicates atrial fibrillation; CKD, chronic kidney disease; COPD, chronic obstructive pulmonary disease; and HF, heart failure. *Mean No. of conditions is 6.1; median is 6. †Mean No. of conditions is 5.5; median is 5. Recommendations for the Management of Comorbidities in Patients With HF (Continued) COR LOE Recommendations Downloaded from http://ahajournals.org by on October 7, 2026