November 1, 2025SHILAP Revista de lepidopterología1 citationsOpen Access
Prognostic impact of heart failure, chronic kidney disease and atherosclerotic disease alone or combined in an elderly population: a retrospective cohort study based on electronic health record data
Structured PICO
Does the presence of HF, CKD, ASCVD, or their combinations increase the risk of mortality and cardiovascular/renal events compared to an unselected elderly population?
P
Population
Adult patients with ASCVD alone (n=19,129), HF alone (n=13,640), CKD alone (n=40,545), cardiorenal syndrome (n=10,499), and other combinations, compared to an unselected control population aged ≥75 years (n=36,532) from an integrated health unit in the North of Portugal.
I
Intervention
Presence of ASCVD, HF, CKD, or combinations thereof
C
Comparator
Unselected control population aged ≥75 years
O
Outcome
All-cause mortality at 1 yearhard clinical
The coexistence of ASCVD, HF, and CKD (atherosclerotic cardiorenal phenotype) synergistically increases the 1-year risk of mortality and adverse cardiovascular/renal events in an elderly population.
Abstract
OBJECTIVES: Heart failure (HF), chronic kidney disease (CKD) and atherosclerotic cardiovascular disease (ASCVD) are highly prevalent conditions that often coexist. Using electronic health records (EHRs), we evaluated the 1-year risk of all-cause death, major cardiovascular and kidney events in patients with HF, CKD, ASCVD and with combinations of these conditions, compared with an unselected control population aged ≥75 years. DESIGN: Retrospective cohort study based on EHR data. SETTING: Integrated primary and secondary health unit located in the North of Portugal. Eligible adult patients were identified using EHRs from 2008 to June 2022. PARTICIPANTS: Eight cohorts were defined: (1) control: patients with ≥75 years; (2) ASCVD alone; (3) HF alone; (4) CKD alone; (5) cardiorenal syndrome (CRS): combined HF+CKD; (6) atherosclerotic HF: combined ASCVD+HF without CKD; (7) atherosclerotic CKD: combined ASCVD+CKD without HF and (8) combined ASCVD+CRS. The risk of these conditions was compared with controls using propensity score age-sex matching. We identified 19 129 patients with ASCVD alone, 13 640 patients with HF alone, 40 545 with CKD alone and 10 499 with CRS. The control group comprised 36 532 patients aged 75 years or older. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was all-cause mortality. The main secondary outcomes were cardiovascular death, HF hospitalisations and end-stage renal disease. RESULTS: The 1-year mortality rate was 0.65% in the control cohort, 5.6% for patients with ASCVD alone, 6.05% for patients with HF alone and 3.53% for patients with CKD alone. Adjusted risk of all-cause death was significantly increased in the ASCVD-alone (HR: 8.42, 95% CI 7.12 to 9.95), HF-alone (HR: 9.19, 95% CI 7.75 to 10.9) and CKD-alone (HR: 5.35, 95% CI 4.62 to 6.19) cohorts, compared with control population; however, patients with the combination of all three conditions (ie, ASCVD+CRS) had the highest mortality risk (HR: 14.18, 95% CI 11.62 to 17.3). A similar association pattern was observed for cardiovascular death, HF events and end-stage renal disease. CONCLUSIONS: Our results support the concept of an atherosclerotic cardiorenal phenotype, with a very high risk of mortality, cardiovascular and renal adverse events. Implementation strategies are required to target these conditions simultaneously.