Clinical profile and comorbidity burden of patients with heart failure in routine cardiology practice: a web-based cross-sectional survey
M Tokmakova, P Gatzov, N Runev, E Trendafilova, Y Yotov, S Tisheva, A Vladimirova, R RaychevaAbstract
Background
Heart failure (HF) frequently coexists with cardiovascular, renal, and metabolic comorbidities, shaping clinical presentation and management. Contemporary real-world descriptions of patient profiles across routine cardiology practice remain limited.
Purpose
To describe demographic characteristics, HF phenotype, comorbidity burden, and key clinical features in the overall population included in a web-based survey.
Methods
A steering committee developed a web-based cross-sectional survey completed by cardiologists from hospital and outpatient practice. Consecutive patients with HF were prospectively reported during a fixed period (1 June–10 July 2025). Data were presented as median (IQR) for continuous variables and n (%) for categorical variables. Missing data were reported as counts and percentages without imputation.
Results
Overall, 1,438 patients were included; 971 (67.5%) were managed as outpatients and 467 (32.5%) were hospitalized. Median age was 70 (IQR 14) years and 57.9% were male. Heart failure phenotype was distributed as HF with reduced ejection fraction 28.4%, mildly reduced ejection fraction 31.6%, and preserved ejection fraction 39.9%. Functional limitation was common (New York Heart Association class II 39.9% and class III 49.4%). Signs of congestion were frequent, including pulmonary rales (46.8%) and peripheral oedema (46.7%); jugular venous distension was present in 20.2% and ascites in 4.1%. Comorbidities were prevalent: hypertension 93.1%, ischemic etiology 49.6%, history of atrial fibrillation 40.1%, type 2 diabetes 43.2%, and chronic kidney disease 35.5%; 39.4% were current smokers. Overweight (40.2%) and obesity (15.7%) were common. Echocardiography frequently showed left ventricular hypertrophy (73.2%) and left atrial enlargement (69.7%), with moderate-to-severe mitral and tricuspid regurgitation in 31.4% and 33.1%, respectively. Commonly used therapies included beta-blockers (85.8%), loop diuretics (79.0%), mineralocorticoid receptor antagonists (58.4%), and sodium–glucose cotransporter-2 inhibitors (82.1%).
Conclusion
This large real-world cohort demonstrates an older, predominantly symptomatic HF population with a high burden of cardio-renal-metabolic comorbidity, congestion, and structural cardiac abnormalities. These descriptive findings provide a contemporary baseline for benchmarking care pathways and identifying priorities for integrated management strategies.For image description, please refer to the figure legend and surrounding text.