{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T22:46:34Z","timestamp":1791413194367,"version":"4.3.3"},"reference-count":49,"publisher":"Springer Science and Business Media LLC","issue":"9","license":[{"start":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T00:00:00Z","timestamp":1768780800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T00:00:00Z","timestamp":1768780800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Medizinische Fakult\u00e4t Mannheim der Universit\u00e4t Heidelberg"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Clin Res Cardiol"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Objective<\/jats:title>\n                    <jats:p>Related to ongoing demographic, the number of patients with cardiac and non-cardiac comorbidities increases. Heart failure with mildly reduced ejection fraction (HFmrEF) represents a heterogeneous population with diverse clinical profiles. The study investigates the prevalence and prognostic impact of multimorbidity in patients hospitalized with HFmrEF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Consecutive patients with HFmrEF were retrospectively included at one institution from 2016 to 2022 and divided into four groups based on the number of concomitant comorbidities taking into account 12 comorbidities (i.e., 0\u20131, 2\u20133, 4\u20135,\u2009\u2265\u20096 comorbidities). The prognostic impact of the number of comorbidities was investigated with regard to the primary endpoint all-cause mortality at 30\u00a0months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>From 2,184 patients hospitalized with HFmrEF, 37% presented with 4\u20135\u00a0comorbidities, 17% with\u2009\u2265\u20096 comorbidities. Compared to patients with 4\u20135, 2\u20133, 0\u20131 comorbidities, patients with\u2009\u2265\u20096 comorbidities were more frequently discharged with beta-blockers (83.6% vs. 78.7% vs. 77.6% vs. 64.7%; p\u2009=\u20090.001) and mineralocorticoid receptor antagonists (MRA) (17.2% vs. 15.7% vs. 12.8% vs. 7.9%; p\u2009=\u20090.004). The risk of all-cause mortality at 30\u00a0months was higher in patients with\u2009\u2265\u20096 comorbidities compared to patients with less comorbidities (i.e., 4\u20135, 2\u20133, 0\u20131) (59.5% vs. 38.6% vs. 17.0% vs. 7.9%, p\u2009=\u20090.001). Both cardiovascular (HR\u2009=\u20091.106; 95% CI 1.030 \u2013 1.188; p\u2009=\u20090.006) and non-cardiovascular (HR\u2009=\u20091.564; 95% CI 1.470 \u2013 1.664; p\u2009=\u20090.001) comorbidities predicted the risk of long-term all-cause mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In patients hospitalized with HFmrEF, more than 50% had at least 4 comorbidities. Both cardiovascular and non-cardiovascular comorbidities predicted the risk of long-term all-cause mortality in HFmrEF.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00392-025-02840-z","type":"journal-article","created":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T10:22:49Z","timestamp":1768818169000},"page":"1615-1628","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Prevalence and prognosis of multimorbidity in heart failure with  mildly reduced ejection fraction"],"prefix":"10.1007","volume":"115","author":[{"given":"Marielen","family":"Reinhardt","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Behnes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad","family":"Abumayyaleh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Bertsch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Goertz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noah","family":"Abel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Schmitt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix","family":"Lau","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonas","family":"Dudda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathrin","family":"Weidner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ibrahim","family":"Akin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobias","family":"Schupp","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,1,19]]},"reference":[{"issue":"17","key":"2840_CR1","doi-asserted-by":"publisher","first-page":"3272","DOI":"10.1093\/cvr\/cvac013","volume":"118","author":"G Savarese","year":"2023","unstructured":"Savarese G et al (2023) Global burden of heart failure: a comprehensive and updated review of epidemiology. Cardiovasc Res 118(17):3272\u20133287","journal-title":"Cardiovasc Res"},{"issue":"2","key":"2840_CR2","doi-asserted-by":"publisher","first-page":"136","DOI":"10.1016\/j.amjmed.2010.08.017","volume":"124","author":"CY Wong","year":"2011","unstructured":"Wong CY et al (2011) Trends in comorbidity, disability, and polypharmacy in heart failure. Am J Med 124(2):136\u2013143","journal-title":"Am J Med"},{"issue":"6","key":"2840_CR3","doi-asserted-by":"publisher","first-page":"1032","DOI":"10.1002\/ejhf.1818","volume":"22","author":"MS Khan","year":"2020","unstructured":"Khan MS et al (2020) Trends in prevalence of comorbidities in heart failure clinical trials. Eur J Heart Fail 22(6):1032\u20131042","journal-title":"Eur J Heart Fail"},{"issue":"5","key":"2840_CR4","doi-asserted-by":"publisher","first-page":"319","DOI":"10.1016\/j.jamda.2013.01.001","volume":"14","author":"JY Le Reste","year":"2013","unstructured":"Le Reste JY et al (2013) The European General Practice Research Network presents a comprehensive definition of multimorbidity in family medicine and long term care, following a systematic review of relevant literature. J Am Med Dir Assoc 14(5):319\u2013325","journal-title":"J Am Med Dir Assoc"},{"issue":"9836","key":"2840_CR5","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1016\/S0140-6736(12)60240-2","volume":"380","author":"K Barnett","year":"2012","unstructured":"Barnett K et al (2012) Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet 380(9836):37\u201343","journal-title":"Lancet"},{"issue":"9836","key":"2840_CR6","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1016\/S0140-6736(12)60482-6","volume":"380","author":"C Salisbury","year":"2012","unstructured":"Salisbury C (2012) Multimorbidity: redesigning health care for people who use it. Lancet 380(9836):7\u20139","journal-title":"Lancet"},{"issue":"18","key":"2840_CR7","first-page":"e895","volume":"145","author":"PA Heidenreich","year":"2022","unstructured":"Heidenreich PA et al (2022) 2022 AHA\/ACC\/HFSA guideline for the management of heart failure: a report of the American College of Cardiology\/American Heart Association joint committee on clinical practice guidelines. Circulation 145(18):e895\u2013e1032","journal-title":"Circulation"},{"key":"2840_CR8","unstructured":"McDonagh TA et al (2022) 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). With the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 24(1):4\u2013131"},{"issue":"1","key":"2840_CR9","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1007\/s40258-017-0346-6","volume":"16","author":"L Wang","year":"2018","unstructured":"Wang L et al (2018) A systematic review of cost-of-illness studies of multimorbidity. Appl Health Econ Health Policy 16(1):15\u201329","journal-title":"Appl Health Econ Health Policy"},{"issue":"2","key":"2840_CR10","doi-asserted-by":"publisher","first-page":"282","DOI":"10.1111\/hex.13166","volume":"24","author":"J Larkin","year":"2021","unstructured":"Larkin J et al (2021) The experience of financial burden for people with multimorbidity: a systematic review of qualitative research. Health Expect 24(2):282\u2013295","journal-title":"Health Expect"},{"issue":"1","key":"2840_CR11","doi-asserted-by":"publisher","first-page":"e16","DOI":"10.1016\/S2589-7500(22)00187-X","volume":"5","author":"V Kuan","year":"2023","unstructured":"Kuan V et al (2023) Identifying and visualising multimorbidity and comorbidity patterns in patients in the English National Health Service: a population-based study. Lancet Digit Health 5(1):e16\u2013e27","journal-title":"Lancet Digit Health"},{"issue":"4","key":"2840_CR12","doi-asserted-by":"publisher","first-page":"2500","DOI":"10.1002\/ehf2.13954","volume":"9","author":"S Takeuchi","year":"2022","unstructured":"Takeuchi S et al (2022) Multimorbidity, guideline-directed medical therapies, and associated outcomes among hospitalized heart failure patients. ESC Heart Fail 9(4):2500\u20132510","journal-title":"ESC Heart Fail"},{"issue":"4","key":"2840_CR13","doi-asserted-by":"publisher","first-page":"854","DOI":"10.1002\/ejhf.3112","volume":"26","author":"D Tomasoni","year":"2024","unstructured":"Tomasoni D et al (2024) The role of multimorbidity in patients with heart failure across the left ventricular ejection fraction spectrum: data from the Swedish Heart Failure Registry. Eur J Heart Fail 26(4):854\u2013868","journal-title":"Eur J Heart Fail"},{"issue":"12","key":"2840_CR14","doi-asserted-by":"publisher","first-page":"2305","DOI":"10.1111\/jgs.15590","volume":"66","author":"M Tisminetzky","year":"2018","unstructured":"Tisminetzky M et al (2018) Multimorbidity burden and adverse outcomes in a community-based cohort of adults with heart failure. J Am Geriatr Soc 66(12):2305\u20132313","journal-title":"J Am Geriatr Soc"},{"key":"2840_CR15","doi-asserted-by":"publisher","DOI":"10.3390\/jcm13133979","author":"A Gracia Guti\u00e9rrez","year":"2024","unstructured":"Gracia Guti\u00e9rrez A et al (2024) Multimorbidity in incident heart failure: characterisation and impact on 1-year outcomes. J Clin Med. https:\/\/doi.org\/10.3390\/jcm13133979","journal-title":"J Clin Med"},{"issue":"10120","key":"2840_CR16","doi-asserted-by":"publisher","first-page":"572","DOI":"10.1016\/S0140-6736(17)32520-5","volume":"391","author":"N Conrad","year":"2018","unstructured":"Conrad N et al (2018) Temporal trends and patterns in heart failure incidence: a population-based study of 4 million individuals. Lancet 391(10120):572\u2013580","journal-title":"Lancet"},{"issue":"1","key":"2840_CR17","doi-asserted-by":"publisher","first-page":"498","DOI":"10.1186\/s12872-023-03527-x","volume":"23","author":"KS Lee","year":"2023","unstructured":"Lee KS et al (2023) Relationship between comorbidity and health outcomes in patients with heart failure: a systematic review and meta-analysis. BMC Cardiovasc Disord 23(1):498","journal-title":"BMC Cardiovasc Disord"},{"issue":"7","key":"2840_CR18","doi-asserted-by":"publisher","first-page":"1469","DOI":"10.1111\/jgs.14206","volume":"64","author":"SM Manemann","year":"2016","unstructured":"Manemann SM et al (2016) Multimorbidity in heart failure: effect on outcomes. J Am Geriatr Soc 64(7):1469\u20131474","journal-title":"J Am Geriatr Soc"},{"issue":"5","key":"2840_CR19","first-page":"493","volume":"79","author":"M Correale","year":"2021","unstructured":"Correale M et al (2021) Non-cardiovascular comorbidities in heart failure patients and their impact on prognosis. Kardiol Pol 79(5):493\u2013502","journal-title":"Kardiol Pol"},{"issue":"4","key":"2840_CR20","doi-asserted-by":"publisher","first-page":"425","DOI":"10.1007\/s11936-013-0249-2","volume":"15","author":"EF Lewis","year":"2013","unstructured":"Lewis EF (2013) Assessing the impact of heart failure therapeutics on quality of life and functional capacity. Curr Treat Options Cardiovasc Med 15(4):425\u2013436","journal-title":"Curr Treat Options Cardiovasc Med"},{"issue":"1","key":"2840_CR21","doi-asserted-by":"publisher","first-page":"154","DOI":"10.1016\/j.ijcard.2014.05.001","volume":"175","author":"CA Rushton","year":"2014","unstructured":"Rushton CA, Kadam UT (2014) Impact of non-cardiovascular disease comorbidity on cardiovascular disease symptom severity: a population-based study. Int J Cardiol 175(1):154\u2013161","journal-title":"Int J Cardiol"},{"key":"2840_CR22","doi-asserted-by":"publisher","first-page":"132","DOI":"10.1016\/j.ijcard.2018.04.001","volume":"271","author":"KW Streng","year":"2018","unstructured":"Streng KW et al (2018) Non-cardiac comorbidities in heart failure with reduced, mid-range and preserved ejection fraction. Int J Cardiol 271:132\u2013139","journal-title":"Int J Cardiol"},{"issue":"1","key":"2840_CR23","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1002\/ejhf.30","volume":"16","author":"VM van Deursen","year":"2014","unstructured":"van Deursen VM et al (2014) Co-morbidities in patients with heart failure: an analysis of the European Heart Failure Pilot Survey. Eur J Heart Fail 16(1):103\u2013111","journal-title":"Eur J Heart Fail"},{"issue":"13","key":"2840_CR24","doi-asserted-by":"publisher","first-page":"1346","DOI":"10.1093\/eurjpc\/zwad151","volume":"30","author":"O Chioncel","year":"2023","unstructured":"Chioncel O et al (2023) Comprehensive characterization of non-cardiac comorbidities in acute heart failure: an analysis of ESC-HFA EURObservational Research Programme Heart Failure Long-Term Registry. Eur J Prev Cardiol 30(13):1346\u20131358","journal-title":"Eur J Prev Cardiol"},{"issue":"6","key":"2840_CR25","doi-asserted-by":"publisher","first-page":"1022","DOI":"10.1002\/ejhf.1795","volume":"22","author":"AS Bhatt","year":"2020","unstructured":"Bhatt AS et al (2020) The burden of non-cardiac comorbidities and association with clinical outcomes in an acute heart failure trial - insights from ASCEND-HF. Eur J Heart Fail 22(6):1022\u20131031","journal-title":"Eur J Heart Fail"},{"issue":"11","key":"2840_CR26","doi-asserted-by":"publisher","first-page":"1994","DOI":"10.1002\/ejhf.3039","volume":"25","author":"O Chioncel","year":"2023","unstructured":"Chioncel O et al (2023) Non-cardiac comorbidities and intensive up-titration of oral treatment in patients recently hospitalized for heart failure: insights from the STRONG-HF trial. Eur J Heart Fail 25(11):1994\u20132006","journal-title":"Eur J Heart Fail"},{"issue":"1","key":"2840_CR27","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1016\/j.amjmed.2014.08.024","volume":"128","author":"AM Chamberlain","year":"2015","unstructured":"Chamberlain AM et al (2015) Multimorbidity in heart failure: a community perspective. Am J Med 128(1):38\u201345","journal-title":"Am J Med"},{"issue":"6","key":"2840_CR28","first-page":"526","volume":"9","author":"D Stolfo","year":"2023","unstructured":"Stolfo D et al (2023) Heart failure pharmacological treatments and outcomes in heart failure with mildly reduced ejection fraction. Eur Heart J 9(6):526\u2013535","journal-title":"Eur Heart J"},{"key":"2840_CR29","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1016\/j.ijcard.2020.04.068","volume":"313","author":"G Savarese","year":"2020","unstructured":"Savarese G et al (2020) Comorbidities and cause-specific outcomes in heart failure across the ejection fraction spectrum: a blueprint for clinical trial design. Int J Cardiol 313:76\u201382","journal-title":"Int J Cardiol"},{"key":"2840_CR30","doi-asserted-by":"publisher","DOI":"10.1002\/ejhf.3337","author":"T Schupp","year":"2024","unstructured":"Schupp T et al (2024) Prevalence and prognosis of aortic valve diseases in patients hospitalized with heart failure with mildly reduced ejection fraction. Eur J Heart Fail. https:\/\/doi.org\/10.1002\/ejhf.3337","journal-title":"Eur J Heart Fail"},{"key":"2840_CR31","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2024.132386","volume":"414","author":"N Abel","year":"2024","unstructured":"Abel N et al (2024) Left ventricular diastolic dysfunction in patients with heart failure with mildly reduced ejection fraction. Int J Cardiol 414:132386","journal-title":"Int J Cardiol"},{"issue":"8","key":"2840_CR32","doi-asserted-by":"publisher","first-page":"893","DOI":"10.1093\/ejechocard\/jep151","volume":"10","author":"BA Popescu","year":"2009","unstructured":"Popescu BA et al (2009) European Association of Echocardiography recommendations for training, competence, and quality improvement in echocardiography. Eur J Echocardiogr 10(8):893\u2013905","journal-title":"Eur J Echocardiogr"},{"issue":"4","key":"2840_CR33","doi-asserted-by":"publisher","first-page":"347","DOI":"10.1164\/rccm.201204-0596PP","volume":"187","author":"J Vestbo","year":"2013","unstructured":"Vestbo J et al (2013) Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med 187(4):347\u2013365","journal-title":"Am J Respir Crit Care Med"},{"issue":"3","key":"2840_CR34","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1002541","volume":"15","author":"J Tromp","year":"2018","unstructured":"Tromp J et al (2018) Multimorbidity in patients with heart failure from 11 Asian regions: a prospective cohort study using the ASIAN-HF registry. PLoS Med 15(3):e1002541","journal-title":"PLoS Med"},{"issue":"5","key":"2840_CR35","doi-asserted-by":"publisher","first-page":"687","DOI":"10.1002\/ejhf.2856","volume":"25","author":"P Dewan","year":"2023","unstructured":"Dewan P et al (2023) Impact of multimorbidity on mortality in heart failure with reduced ejection fraction: which comorbidities matter most? An analysis of PARADIGM-HF and ATMOSPHERE. Eur J Heart Fail 25(5):687\u2013697","journal-title":"Eur J Heart Fail"},{"issue":"9","key":"2840_CR36","doi-asserted-by":"publisher","first-page":"1606","DOI":"10.1002\/ejhf.2962","volume":"25","author":"M Yang","year":"2023","unstructured":"Yang M et al (2023) Impact of comorbidities on health status measured using the Kansas City Cardiomyopathy Questionnaire in patients with heart failure with reduced and preserved ejection fraction. Eur J Heart Fail 25(9):1606\u20131618","journal-title":"Eur J Heart Fail"},{"issue":"2","key":"2840_CR37","doi-asserted-by":"publisher","first-page":"100","DOI":"10.1038\/s41569-021-00605-5","volume":"19","author":"G Savarese","year":"2022","unstructured":"Savarese G et al (2022) Heart failure with mid-range or mildly reduced ejection fraction. Nat Rev Cardiol 19(2):100\u2013116","journal-title":"Nat Rev Cardiol"},{"key":"2840_CR38","doi-asserted-by":"publisher","first-page":"86","DOI":"10.1016\/j.ejim.2024.07.009","volume":"130","author":"T Schupp","year":"2024","unstructured":"Schupp T et al (2024) Distribution and prognostic impact of different heart failure etiologies in patients with heart failure with mildly reduced ejection fraction. Eur J Intern Med 130:86\u201397","journal-title":"Eur J Intern Med"},{"key":"2840_CR39","doi-asserted-by":"publisher","DOI":"10.3390\/jcm14010139","author":"F B\u00e1nfi-Bacs\u00e1rdi","year":"2024","unstructured":"B\u00e1nfi-Bacs\u00e1rdi F et al (2024) Therapeutic consequences and prognostic impact of multimorbidity in heart failure: time to act. J Clin Med. https:\/\/doi.org\/10.3390\/jcm14010139","journal-title":"J Clin Med"},{"issue":"6","key":"2840_CR40","doi-asserted-by":"publisher","first-page":"613","DOI":"10.1002\/ejhf.566","volume":"18","author":"MG Crespo-Leiro","year":"2016","unstructured":"Crespo-Leiro MG et al (2016) European Society of Cardiology Heart Failure Long-Term Registry (ESC-HF-LT): 1-year follow-up outcomes and differences across regions. Eur J Heart Fail 18(6):613\u2013625","journal-title":"Eur J Heart Fail"},{"issue":"20","key":"2840_CR41","doi-asserted-by":"publisher","first-page":"2476","DOI":"10.1016\/j.jacc.2017.08.074","volume":"70","author":"KS Shah","year":"2017","unstructured":"Shah KS et al (2017) Heart failure with preserved, borderline, and reduced ejection fraction: 5-year outcomes. J Am Coll Cardiol 70(20):2476\u20132486","journal-title":"J Am Coll Cardiol"},{"key":"2840_CR42","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1016\/j.ijcard.2019.08.049","volume":"298","author":"G Savarese","year":"2020","unstructured":"Savarese G et al (2020) Prevalence of, associations with, and prognostic role of anemia in heart failure across the ejection fraction spectrum. Int J Cardiol 298:59\u201365","journal-title":"Int J Cardiol"},{"issue":"8","key":"2840_CR43","doi-asserted-by":"publisher","DOI":"10.1111\/eci.14205","volume":"54","author":"T Schupp","year":"2024","unstructured":"Schupp T et al (2024) Effect of anaemia and iron deficiency in heart failure with mildly reduced ejection fraction. Eur J Clin Invest 54(8):e14205","journal-title":"Eur J Clin Invest"},{"issue":"12","key":"2840_CR44","doi-asserted-by":"publisher","first-page":"1574","DOI":"10.1002\/ejhf.813","volume":"19","author":"O Chioncel","year":"2017","unstructured":"Chioncel O et al (2017) Epidemiology and one-year outcomes in patients with chronic heart failure and preserved, mid-range and reduced ejection fraction: an analysis of the ESC Heart Failure Long-Term Registry. Eur J Heart Fail 19(12):1574\u20131585","journal-title":"Eur J Heart Fail"},{"issue":"12","key":"2840_CR45","first-page":"1056","volume":"7","author":"JA Regan","year":"2019","unstructured":"Regan JA et al (2019) Impact of age on comorbidities and outcomes in heart failure with reduced ejection fraction. JACC: Heart Failure 7(12):1056\u20131065","journal-title":"JACC: Heart Failure"},{"issue":"1","key":"2840_CR46","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1002\/ejhf.3024","volume":"26","author":"TA McDonagh","year":"2024","unstructured":"McDonagh TA et al (2024) 2023 Focused Update of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) With the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 26(1):5\u201317","journal-title":"Eur J Heart Fail"},{"issue":"5","key":"2840_CR47","doi-asserted-by":"publisher","first-page":"956","DOI":"10.1002\/ehf2.12338","volume":"5","author":"R Rodil Fraile","year":"2018","unstructured":"Rodil Fraile R, Malafarina V, Tiberio L\u00f3pez G (2018) Sacubitril-valsartan in heart failure and multimorbidity patients. ESC Heart Fail 5(5):956\u2013959","journal-title":"ESC Heart Fail"},{"issue":"3","key":"2840_CR48","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.124.011598","volume":"18","author":"M Yang","year":"2025","unstructured":"Yang M et al (2025) Impact of multimorbidity on mortality in heart failure with mildly reduced and preserved ejection fraction. Circ Heart Fail 18(3):e011598","journal-title":"Circ Heart Fail"},{"key":"2840_CR49","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.ijcard.2016.03.001","volume":"212","author":"S Stewart","year":"2016","unstructured":"Stewart S et al (2016) Establishing a pragmatic framework to optimise health outcomes in heart failure and multimorbidity (ARISE-HF): a multidisciplinary position statement. Int J Cardiol 212:1\u201310","journal-title":"Int J Cardiol"}],"container-title":["Clinical Research in Cardiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00392-025-02840-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00392-025-02840-z","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00392-025-02840-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T09:03:04Z","timestamp":1786352584000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00392-025-02840-z"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,19]]},"references-count":49,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["2840"],"URL":"https:\/\/doi.org\/10.1007\/s00392-025-02840-z","relation":{},"ISSN":["1861-0684","1861-0692"],"issn-type":[{"value":"1861-0684","type":"print"},{"value":"1861-0692","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,19]]},"assertion":[{"value":"5 September 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 December 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 January 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"No conflict of interest for all authors.","order":1,"name":"Ethics","label":"Conflict of interests","group":{"name":"EthicsHeading","label":"Declarations"}}]}}