Pupalan Iyngkaran*, Merlin Thomas, John D Horowitz, Paul Komesaroff, Michael Jelinek and David L Hare Pages 1 - 12 ( 12 )
At least half of all heart failure (CHF) patients will have a comorbidity that could be undertreated, requires additional speciality input and/or polypharmacy. These patients are then at risk from iatrogenic and disease related complications and readmissions if not closely supervised. Common comorbidities of relevance are cardiorenal and cardiometabolic syndromes (DM, obesity, OSA), chronic airways disease, elderly age and accompanying therapeutic optimisation. The structure of community practice often leaves primary, speciality and allied health care in silos. For example, cardiology speciality training in Australia creates excellent sub-specialists to deliver on the diagnostics and therapeutic advances. A casualty of this process has been gradual alienation of general cardiology towards general internal medical specialists and GP's. The consequences are largely noticed in community practice. The issue are compounded by suboptimal communication of information. This review explores these issues from a cardiology sub-speciality lens, firstly cross speciality areas important for cardiologist to maintain their skill and finally a brief overview of disease management and identifying game changing common denominators such as endothelial dysfunction and self-management.
Comorbidity, congestive heart failure, disease management, process of care, performance markers, specialist training, obesity, metabolically healthy obesity, obesity paradox, cardiovascular disease, cardiometabolic syndrome
Department of Cardiology, Cardiologist (Heart Failure & Cardiac Imaging) Heart West, Adjunct Senior Lecturer, Werribee Mercy Sub School, School of Medicine, Notre Dame University, Notre Dame, Sydney, Department of Biochemistry, Biochemistry of Diabetes Complications, Monash University, Melbourne, Department of Cardiology, University of Adelaide, Adelaide, Department of Endocrinology, Professor of Medicine, Monash University, Melbourne, University of Melbourne, St. Vincent's Hospital, Melbourne, Department of Cardiology, Cardiovascular Research, University of Melbourne, Austin Health, Melbourne, Victoria