Cardiovascular-kidney-metabolic overlaps, clinical outcomes, and quality of life in patients with acute heart failure

Background

The impact of cardiovascular-kidney-metabolic (CKM) multimorbidity on outcomes in heart failure (HF) patients from China is not well-characterized.

Objectives

To evaluate the influence of CKM multimorbidity on short-term and long-term clinical outcomes and health-related quality of life.

Methods

Using data from a multicenter prospective cohort in China, we classified patients hospitalized for HF according to numbers or combinations of CKM conditions (atherosclerotic cardiovascular disease [ASCVD]), chronic kidney disease [CKD], and type 2 diabetes [T2D]). Cox regression models assessed associations of CKM multimorbidity with 1-year major adverse cardiovascular events (MACE), all-cause death, cardiovascular (CV) death, all-cause rehospitalization, HF rehospitalization, and 4-year mortality outcomes. Generalized linear models evaluated CKM multimorbidity’s impact on 12-item Kansas City Cardiomyopathy Questionnaire (KCCQ-12) scores at 1, 6, and 12 months post-discharge.

Results

Among 4875 patients, 68.2% had at least one CKM condition, and 8.0% had all three. Having three CKM conditions significantly increased 1-year MACE (adjusted hazard ratio [aHR] 1.87), all-cause death (aHR 1.78), CV death (aHR 1.78), all-cause rehospitalization (aHR 1.70), HF rehospitalization (aHR 1.76), 4-year all-cause death (aHR 1.95), and CV death (aHR 1.78). Patients with three CKM conditions had a 12-month KCCQ-12 score difference of −6.35 compared to those with no CKM conditions.

Conclusions

CKM multimorbidity is common in Chinese patients hospitalized for HF and is associated with a higher risk of clinical outcomes and lower health-related quality of life.