## 5 Discussion
### Comorbidities in HFmrEF  
Comorbidities are independent predictors of patients with HFmrEF and should be considered in a clinical trial of HFmrEF. In the study \"Comorbidities, fragility and quality of life in patients with HFmrEF\", comorbidities significantly affected patient outcomes (both morbidity and mortality). This effect was unexpectedly higher in patients with HFmrEF than in patients with HFrEF and HFpEF. In particular, hypertension, coronary heart disease,  
\begin{table}
\begin{tabular}{l c c c} \hline \hline
**Predictor** & & **OR (95\% CI)** & \(p\)**-Value** \\ \hline
**Medication** & & & \\ ACEI/ARB & Yes (ref. no) & 0.98 (0.62–1.55) & 0.929 \\ Beta-blockers & Yes (ref. no) & 2.37 (1.41–3.97) & **0.001** \\ Furosemide & Yes (ref. no) & 5.58 (4.01–7.77) & **<0.001** \\ Hydrochlorothiazzide & Yes (ref. no) & 0.35 (0.23–0.54) & **<0.001** \\ MRA & Yes (ref. no) & 3.53 (2.60–4.77) & **<0.001** \\ \hline \hline \end{tabular}
\end{table}
Table 2: _Cont._  
Figure 1: The 2-year event-free survival without achieving a combined endpoint (combined endpoint: all causes of death, LVAD or OHT) in patients with chronic heart failure according to LVEF value. CI, confidential interval; LVEF, left ventricular ejection fraction; For LVEF < 40% (LVEF 40–49% as a reference): HR = 1.85 (95% CI: 1.18–2.89); \(p\) < 0.001.  
atrial fibrillation and renal failure have a direct link to heart failure. Anemia often develops with heart failure and is associated with a worse prognosis. The relationship between DM and heart failure is two-way and the incidence of DM in heart failure is significant. Patients with DM have an increased risk of heart failure and DM is also associated with a poor prognosis. Renal insufficiency is very common due to the interdependence of the kidneys and the heart. Patients with heart failure and renal insufficiency also have a poor prognosis. Even a slight deterioration in renal parameters is associated with higher mortality. However, there is limited evidence that specific treatment for comorbidities is associated with a lower incidence of serious cardiovascular events regardless of LVEF. This may be due to the fact that comorbidities are more often addressed in patients with HFrEF. Based on the results of the study, patients with HFrnrEF may be an ideal group for the targeted treatment of comorbidities, due to the effect of comorbidities on the prognosis and, so far, less severe heart failure [4].  
The study \"Non-cardiac comorbidities in heart failure with HFrEF, HFrnrEF and HFpEF\" looked at other comorbidities, including thyroid dysfunction, obesity, COPD, stroke and peripheral arterial disease. The association of each comorbidity with quality of life, mortality from all causes and hospitalization was evaluated. The highest prevalence of comorbidities was observed in patients with HFpEF. Comorbidities were associated with lower quality of life, but this was more pronounced in patients with HFrEF [5].  
There was no difference in the proportion of comorbidities in the HFrnrEF groups compared to HFrEF in our group. Of the monitored comorbidities, i.e., hypertension, dyslipidemia, COPD, DM and ICHDKK, hypertension and dyslipidemia were the most represented in both subgroups.