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Heart Failure Mortality in Chronic Kidney Disease: The Fatal Crossover
Yong-Hao Yeo1, Boon-Jian San2, Xuan-Ci Mee3
1Department of Internal Medicine-Pediatrics, Corewell Health William Beaumont University Hospital, Royal Oak, MI.
Insights
Mortality from heart failure in patients with chronic kidney disease significantly increased from 2011 to 2020. Targeted interventions and policy changes are crucial for this vulnerable population.
Area of Science:
- Cardiology
- Nephrology
- Public Health
Background:
- Limited real-world mortality data exists for heart failure (HF) patients with comorbid chronic kidney disease (CKD), particularly with recent advancements in HF therapies.
- Understanding mortality trends in this population is crucial for developing effective treatment strategies and public health interventions.
Purpose of the Study:
- To analyze real-world mortality trends for heart failure patients with comorbid chronic kidney disease.
- To identify demographic and regional disparities in heart failure mortality among patients with CKD.
Main Methods:
- Utilized the CDC WONDER database for mortality data from 2011-2020.
- Included patients aged 25 and older who died primarily from heart failure with comorbid chronic kidney disease.
- Calculated age-adjusted mortality rates (AAMR) and analyzed trends using Joinpoint regression to estimate annual percent change (APC).
Main Results:
- A total of 82,454 heart failure deaths with comorbid CKD were recorded.
- Age-adjusted mortality rates (AAMR) for HF with CKD increased by 149.0% from 2011 to 2020.
- Higher AAMR observed in men, African Americans, the Midwest region, and rural areas. Most deaths occurred in hospice or nursing homes.
Conclusions:
- A significant rise in heart failure AAMR among patients with CKD was observed.
- Further research is needed to optimize cardioprotective therapies for this population.
- Addressing demographic and regional disparities at the policy level is essential.
Background:
Real-world mortality data regarding heart failure in patients with comorbid chronic kidney disease remains limited, especially following the advent of advanced heart failure therapies.
Methods:
Using the CDC WONDER database, we included patients ≥ 25 years old who died primarily from heart failure (2011-2020) with comorbid chronic kidney disease. We calculated age-adjusted mortality rates (AAMR) per 100,000 individuals. We determined the trends over time by estimating the annual percent change (APC) using the Joinpoint regression program.
Results:
There were 82,454 heart failure deaths with comorbid chronic kidney disease. The AAMR increased from 2.34 (95% CI, 2.28-2.41) in 2011 to 4.79 (95% CI, 4.71-4.88) in 2020. During the study period, Heart failure deaths among patients with comorbid chronic kidney disease increased by 149.0% compared to 59.9% in those without. Men had higher AAMR than women (3.92 [95% CI, 3.88-3.96] vs. 2.96 [95% CI, 2.93-2.99]). African American patients had the highest AAMR (5.85 [95% CI, 5.75-5.96]). The Midwest region had the highest AAMR (3.83 [95% CI, 3.78-3.89]). The AAMR was higher in the rural areas than in the urban regions (3.77 [95% CI, 3.71-3.83] vs. 3.23 [95% CI, 3.20-3.25]). Most patients died in hospices or nursing homes (29,000, 35.2%).
Conclusion:
Our study showed a significant increase in heart failure AAMR in patients with comorbid chronic kidney disease in recent eras. Further effort is needed to optimize cardioprotective agents for this population and to address demographic discrepancies at the policy level.
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