LAUSR

We would like to thank Maggioni et al. for their recent publication investigating the comorbidities/patient characteristics in heart failure (HF) that are found in the real world, as opposed to those garnered from clinical trials.1 The top co-morbidities observed were diabetes, COPD, and depression;1 despite the plethora of other disease states that HF patients often harbour,2 the fact that an affective disorder such as depression ranks in the top three is unsurprising: depression is an independent predictor of mortality in HF3, and depressed HF patients exhibit a mortality rate twice that of non-depressed HF patients.4 These observations resonate with our experience: HF patients either exhibit cognitive decline or manifest depressive symptoms enough effectively to stymie the execution of consistent self-care. To add insult to injury,