Background/Objectives: In heart failure (HF) with reduced ejection fraction (HFrEF),
the early diagnosis and proper treatment of comorbidities (CMs) are of fundamental
relevance. Our aim was to assess the prevalence of CMs among real-world patients requiring
hospitalisation for HFrEF and to investigate the effect of CMs on the implementation
of guideline-directed medical therapy (GDMT) and on all-cause mortality (ACM). Methods:
The data of a consecutive HFrEF patient cohort hospitalised for HF between 2021 and
2024 were analysed retrospectively. Sixteen CMs (6 CV and 10 non-CV) were considered.
Patients were divided into three categories: 0–3 vs. 4–6 vs. ≥7 CMs. GDMT at discharge
and ACM were compared among CM categories. The predictors of 1-year ACM were also
evaluated. Results: From the 388 patients (male: 76%, age: 61 [50–70] years; NT-proBNP:
5286 [2570–9923] pg/mL; ≥2 cardiovascular–kidney–metabolic disease overlap: 46%),
a large proportion received GDMT (RASi: 91%; βB: 85%; MRA: 95%; SGLT2i: 59%; triple
therapy [TT: RASi+βB+MRA]: 82%; quadruple therapy [QT: TT + SGLT2i]: 54%) at discharge.
Multimorbidity was accompanied with a (p < 0.05) lower application ratio of RASi (96%
vs. 92% vs. 85%; 0–3 vs. 4–6 vs. ≥7 CMs) and βB therapy (94% vs. 85% vs. 78%), while
MRA (99% vs. 94% vs. 94%) and SGTL2i use (61% vs. 59% vs. 57%) did not differ (p >
0.05). Patients with multimorbidity were less likely to be treated with TT (93% vs.
82% vs. 73%, p = 0.001), while no difference was detected in the implementation of
QT (56% vs. 54% vs. 50%, p = 0.685). The 1-year ACM of patients with an increased
burden of CMs was higher (9% vs. 13% vs. 25%, p = 0.003). The risk of 1-year ACM was
favourably affected by the use of TT/QT and less severe left ventricular systolic
dysfunction, while having ≥5 CMs had an unfavourable impact on prognosis. Conclusions:
According to our real-world analysis, HFrEF patients with an increased burden of CMs
can expect a less favourable outcome. However, modern GDMT can even be applied in
this patient population, resulting in a significantly improved prognosis. Thus, clinicians
should insist on the early, conscious implementation of a prognosis-modifying drug
regime in multimorbid HF patients as well.
