Uptake of Goal-Directed Therapies in a Multidisciplinary and Interdisciplinary Cardiology-Renal-Endocrine Clinic: A Research Letter.

Abstract

The Cardiac and Renal Endocrine (C.a.R.E) clinic is an interdisciplinary clinic offering integrated care to complex patients with cardiovascular-kidney-metabolic syndrome. Previous data from the clinic demonstrated improvements in clinical parameters but provided limited information on the indicated usage of evidence-based therapies. We aimed to update baseline characteristics and clinical data of the C.a.R.E clinic cohort, with added information on the uptake of therapies and reasons for therapy non-use. We performed a retrospective chart review of patients seen in the C.a.R.E clinic between July 2014 and July 2024 with at least two documented clinic visits. Data from the first and last visits were compared to evaluate treatment uptake and changes in clinical parameters. A total of 125 patients met our inclusion criteria. There were significant improvements in low-density lipoprotein levels (1.61 mmol/L for last visit vs 1.82 mmol/L for first visit), blood pressure (BP) measurements, (median systolic BP of 126 mm Hg vs 130 mm Hg and median diastolic BP of 72 mm Hg vs 76 mm Hg), and proportion of patients achieving BP targets (60.0% vs 44.8%). Uptake of therapies significantly increased, including sodium-glucose cotransporter-2 inhibitors (59.2% vs 24.0%) and glucagon-like peptide-1 receptor agonists (30.4% vs 9.6%). The use of finerenone also increased (22.7% vs 3.0%) among the 66 patients whose last visit occurred after Health Canada approved finerenone. The C.a.R.E clinic demonstrates potential to improve therapy uptake and clinical outcomes in patients with cardiovascular-kidney-metabolic syndrome. However, consistent clinical documentation and innovative strategies are needed to further enhance the adoption of evidence-based therapies.