The comorbid patient: does your heart sink?

Most readers of Heart will be no stranger to dealing with the comorbid patient. Cardiologists see increasing numbers of complex patients both in our clinics and on our ward rounds. They can be the most rewarding of cases, but they can also make your heart sink. Frequently, the most difficult case discussions are around higher risk intervention or operations in older patients with comorbidities. The heart might be easy, but it is the rest of the patient that is the problem. Often, individually, none of the comorbidities would be an absolute contraindication to a proposed procedure. However, we have to consider their impact in combination and in totality. What will the natural history of the patient in front of us be with or without our intervention, taking into account the comorbidities—difficult questions to answer? In this issue of Heart , Crowe provides us with a new perspective on comorbid phenotypes.1 No single article is going to give us the answer but this one provides food for thought. Do not let not knowing what a latent class analysis is put you off looking …