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Abstract

Heart failure (HF) is a complex clinical syndrome often resulting from the cumulative impact of multiple cardiovascular risk factors and comorbidities. This longitudinal cohort study aimed to evaluate the contribution of traditional cardiovascular risk factors—hypertension, coronary artery disease, diabetes mellitus, obesity, and valvular heart disease—to the development of heart failure, and to assess treatment outcomes in patients with concurrent comorbid conditions. Using a large electronic health record dataset spanning 2015 to 2024, we analyzed data from over 10,000 individuals aged 40 and above. The findings revealed that diabetes mellitus exhibited the highest adjusted hazard ratio (HR=2.29, 95% CI: 2.10–2.49), followed by coronary artery disease (HR=2.04) and hypertension (HR=1.72), affirming their dominant role in HF onset. Moreover, comorbidities such as chronic kidney disease, anemia, chronic obstructive pulmonary disease (COPD), and atrial fibrillation were shown to significantly worsen prognosis, with chronic kidney disease presenting the highest mortality impact (HR=1.89, p<0.001). Diabetic cardiomyopathy was specified as a separate disease affecting the heart muscles and not simply an additional factor in cardiovascular pathologies; thus, it was detected that there is an increased prevalence of left ventricular dysfunction and myocardial fibrosis among patients with diabetes. Demand study revealed that out of the total prescriptions, diuretics with 81.5% brush used rate were most commonly prescribed but ARNIs and SGLT2 inhibitors had the highest improvements in ejection fraction and less hospitalization. These findings underscore the need for a comprehensive approach to the treatment of patients with heart failure, especially those having multiple conditions. To increase survival status as well as quality of life among the patients with heart failure, effort in risk stratification, individualised treatment and aggressive management of co morbidity should be early instigated.