A heart with glowing circles around it showing different comorbid conditions of heart failure - arthritis, pneumonia and anemia.

Other Comorbidities

Reviewed by: HU Medical Review Board | Last reviewed: November 2019

Many people don’t realize that there is a link between some common medical conditions and heart problems. Improved communications between healthcare providers and patients can help to minimize and monitor added risks.1 Diabetes, obesity, and chronic kidney disease are conditions with well-known connections to heart failure (HF). Yet there are many other comorbidities that get less attention.

Comorbidity is the presence of two or more chronic diseases or conditions in a single person at the same time. Some lesser-known medical conditions that can contribute to the development of or interfere with the management of heart failure include arthritis, gout, pneumonia, and anemia.

Arthritis and gout

According to the Arthritis Foundation, inflammatory conditions like rheumatoid arthritis (RA), psoriatic arthritis, lupus, and gout can place a person at increased risk of developing heart disease. This can range from a heart attack and stroke to high blood pressure, heartbeat irregularities, and heart failure.2

Chronic inflammation is a risk factor for heart disease.2 Even people with well-managed treatment using standard therapies may be at increased risk.1

People with RA have high levels of inflammation and may have other cardiac risk factors like high blood pressure or diabetes. Effective treatment involves the reduction of inflammation as well as other known risk factors. The American Heart Association recognizes six independent risk factors that can be addressed: smoking, high cholesterol, high blood pressure, inactivity, obesity, and diabetes.2 These can help with the heart as well as inflammatory conditions.1

Gout, a type of inflammatory arthritis, affects nearly 6 million men and 2 million women, or about 4 percent of the population, according to the Arthritis Foundation. Gout is caused by the buildup of uric acid levels from the breakdown of purines in the body which cause the formation of needle-like urate crystals in a joint. Symptoms include sudden onset of pain, tenderness, redness, warmth, and swelling, particularly in the big toe.1,3

Gout may cause a decline in heart-related outcomes for people being treated for coronary artery disease. It causes inflammation in the joints and can affect various body organs. Gout is also associated with an increased risk of kidney disease, diabetes, cancer, and sleep apnea; all of which have correlations in heart failure.1


Pneumonia is an inflammation in the lungs caused by an infection. The air sacs within the lobes can fill with fluid or pus with the inflammation affects one or both lungs.4-5

Pneumonia symptoms include cough with phlegm or pus, fever, chills, and difficulty breathing.4 The condition can range from mild to life-threatening. It is generally most critical in the young (under 2) and old (over 65) or those people with other medical conditions or weakened immune systems.4

The association between pneumonia and heart disease has been studied for more than 100 years.6 Clinicians have determined that pneumonia can cause a deterioration in existing cardiac problems. Signs and symptoms of pneumonia and heart failure can be similar and may include:4

  • Chest pain when breathing or coughing
  • Confusion
  • Cough
  • Fatigue
  • Fever, sweating and shaking chills
  • Shortness of breath

Hospitalizations for heart failure and pneumonia are increasingly common among the elderly.5 Heart failure is a risk factor for pneumonia. Studies have reported that pneumonia patients with heart failure were typically older and tended to have a history of hospital-diagnosed comorbidities. Acute respiratory tract infections are the cause of admission for 3–16% of patients hospitalized with decompensated heart failure.5

Healthcare providers and public health entities continue to promote the pneumococcal vaccine. Vaccines may prevent some types of pneumonia and reduce the incidence of pneumonia and heart failure with cardiac decompensation.6 Vaccination guidelines get modified so check with your healthcare provider about what is right for you or your family members.4


Anemia is a blood condition caused by an insufficient supply of healthy red blood cells to carry oxygen to your body's tissues. Red blood cells contain an iron-rich protein called hemoglobin. Hemoglobin helps red blood cells carry oxygen from the lungs throughout the body and moves carbon dioxide to the lungs to be exhaled.7

Anemia can make you feel tired and weak. Symptoms include fatigue, pale or yellow skin, shortness of breath, and/or chest pain. Like pneumonia, some of the symptoms are the same as heart failure.8 Anemia is present in about one-third of all cases of heart failure caused by chronic kidney insufficiency.9 Anemia can lead to a decline in cardiac function due to cardiac stress caused by a heart that is working harder and beating faster. It can also cause a decrease in renal blood flow leading to fluid retention which also puts more strain on the heart.9

This means that HF contributes to worsening anemia. Anemia causes worsening HF resulting in damage to the kidneys leading to more severe anemia and heart failure.9 Iron deficiencies are a direct complication of anemia and can lead to arrhythmias, a rapid or irregular heartbeat. This means the heart has to pump more blood to compensate for reduced blood oxygen supply, which can lead to an enlarged heart or heart failure.7

Always communicate new and ongoing symptoms with your health care team. Taking responsibility for a healthy lifestyle and following recommended treatment plans can help minimize and manage added heart failure risks.

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