Kidney Function and Outcomes in Patients Hospitalized With Heart Failure.

Area of Science:

• Cardiology
• Nephrology
• Clinical Outcomes Research

Background:

• Limited contemporary data evaluate heart failure (HF) care patterns and outcomes across the spectrum of kidney function.
• Understanding these disparities is crucial for improving patient management and survival rates.

Purpose of the Study:

• To characterize differences in quality of care and outcomes for patients hospitalized with HF based on their degree of kidney dysfunction.
• To assess the association between kidney function and the utilization of guideline-directed medical therapies (GDMT) in HF patients.

Main Methods:

• Analysis of 365,494 hospitalizations from the Get With The Guidelines-Heart Failure (GWTG-HF) registry (2014-2019).
• Evaluation of guideline-directed medical therapies based on discharge estimated glomerular filtration rate (eGFR) using CKD-EPI.
• Assessment of the risk-adjusted association between admission eGFR and in-hospital mortality.

Main Results:

• 64% of HF hospitalizations had an eGFR <60 mL/min/1.73 m²; 5% were on dialysis.
• GDMT, including beta-blockers, was least utilized in patients with eGFR <30 mL/min/1.73 m² or on dialysis.
• Triple therapy use decreased significantly with declining eGFR, and mortality risk increased progressively with lower admission eGFR.

Conclusions:

• Patients with comorbid HF and kidney disease face elevated mortality risks and are undertreated with evidence-based therapies.
• Suboptimal treatment occurs even when therapies are not contraindicated by kidney dysfunction.
• Further interventions are needed to mitigate risks in patients with coexisting HF and kidney disease.