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Published on: June 16, 2014
Prognostic Impact of Cardiovascular-Kidney-Metabolic Overlap Among Patients With Acute Heart Failure: Insights From a
Matteo Marchetti1, Panagiotis Antiochos1, Barbara Pitta-Gros1
1Division of Cardiology Lausanne University Hospital (CHUV), University of Lausanne (UNIL) Lausanne Switzerland.
Insights
Cardiovascular-kidney-metabolic multimorbidity significantly increases adverse outcomes in acute heart failure patients. Comprehensive assessment of these conditions is crucial for better patient management and prognosis.
Area of Science:
- Cardiology
- Nephrology
- Metabolic Diseases
- Public Health
Background:
- Prognostic significance of cardiovascular-kidney-metabolic (CKM) multimorbidity in acute heart failure (AHF) is not well-defined.
- CKM multimorbidity involves conditions like heart failure, impaired kidney function, and diabetes.
Purpose of the Study:
- To evaluate the association between CKM multimorbidity and clinical outcomes in a real-world AHF cohort.
- To determine the impact of the number of CKM conditions on AHF patient prognosis.
Main Methods:
- Retrospective analysis of 1745 AHF patients hospitalized between 2005 and 2020.
- Patients categorized by the number of CKM conditions (0-3) including prior myocardial infarction, impaired kidney function, and diabetes.
- Cox models used to assess the association between CKM conditions and HF hospitalization or all-cause death.
Main Results:
- 18.9% had HF alone, while 81.1% had one or more CKM conditions.
- Increasing CKM conditions correlated with a stepwise increase in adverse outcomes.
- Adjusted hazard ratios for 1, 2, and 3 CKM conditions were 1.27, 1.50, and 2.10, respectively.
Conclusions:
- CKM multimorbidity is prevalent in hospitalized AHF patients.
- A higher burden of CKM conditions is linked to increased risk of adverse events.
- Comprehensive CKM assessment is vital for managing AHF patients.
Background:
The prognostic significance of cardiovascular-kidney-metabolic (CKM) multimorbidity in acute heart failure (AHF) remains unclear. We evaluated its association with clinical outcomes in a real-world, multinational cohort of patients with AHF.
Methods:
We included patients with AHF hospitalized from 2005 to 2020 at 2 tertiary care centers in Switzerland and Kyrgyzstan. Patients were categorized based on the number of CKM conditions in addition to HF (0-3). CKM conditions included prior myocardial infarction, impaired kidney function (estimated glomerular filtration rate <60 mL/min/m2), and diabetes. The association between the number of CKM conditions and the primary outcome of HF hospitalization or all-cause death was assessed with Cox models.
Results:
Among 1745 patients (69% Swiss, 44% female, age 74±13 years, left ventricular ejection fraction 43±16%), at baseline, 18.9% had HF alone, 39.0% had 1 CKM condition, 30.7% had 2, 11.4% had 3. Impaired kidney function was the most prevalent CKM condition (n=1011), followed by prior myocardial infarction (n=742) and diabetes (n=595). At 1 year, 731 patients (41.9%) experienced the primary outcome. Compared with HF alone, an increasing number of CKM conditions was associated with stepwise increases in the risk of the primary outcome (adjusted hazard ratios [HRs], 1.27 [95% CI, 1.01-1.59], 1.50 [95% CI, 1.19-1.89], and 2.10 [95% CI, 1.59-2.77] for 1, 2, and 3 CKM conditions). These associations remained consistent regardless of sex, age, and left ventricular ejection fraction (Pinteraction>0.05 for all).
Conclusions:
In this real-world cohort of hospitalized patients with AHF, CKM multimorbidity was common and associated with a stepwise increase in the risk of adverse outcomes. These data underscore the importance of comprehensive CKM assessment in an AHF setting.
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