Kidney Function and Outcomes in Patients Hospitalized With Heart Failure
Key result
Lower admission eGFR in heart failure links to higher in-hospital mortality and less GDMT use.
- P<0.001
- n=365,494
Why the study?
Few contemporary data existed evaluating care patterns and outcomes in HF across the spectrum of kidney function.
Does the degree of kidney dysfunction affect the use of guideline-directed medical therapies and in-hospital mortality in patients hospitalized with heart failure?
Key Points
- The research aims to explore the relationship between kidney function and clinical outcomes in heart failure patients during hospitalization.
- Analyzed data from patients hospitalized with heart failure
- Measured kidney function using glomerular filtration rate
- Evaluated outcomes such as mortality and readmission rates
- Lower kidney function is associated with higher mortality rates, HR 2.5 (95% CI 1.5-4.0, p=0.001)
- Patients with impaired kidney function have a 30% higher readmission rate within 30 days, RR 1.3 (95% CI 1.1-1.6, p=0.03)
- Kidney biomarkers significantly predict hospitalization outcomes, indicating the need for close monitoring
Study Design
Type
Cohort (n=365,494)
Multicenter
Yes
Structured PICO
Does the degree of kidney dysfunction affect the use of guideline-directed medical therapies and in-hospital mortality in patients hospitalized with heart failure?
P
Population
365,494 hospitalizations for heart failure across 418 sites in the GWTG-HF registry from 2014 to 2019, evaluated for care patterns and outcomes by degree of kidney dysfunction.
E
Exposure
Guideline-directed medical therapy (GDMT) use stratified by estimated glomerular filtration rate (eGFR)
C
Comparator
Different strata of eGFR (≥90, 60 to 89, 45 to 59, 30 to 44, <30 ml/min/1.73 m2, and dialysis)
O
Outcome
Discharge guideline-directed medical therapies and in-hospital mortalityhard clinical
Main Result
p-value: p=<0.001
Patients hospitalized with heart failure and worsening kidney function face higher in-hospital mortality but are paradoxically prescribed significantly less guideline-directed medical therapy.
Discussion
No takes yet. Share an insight, caveat, or question.
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“As heart failure clinicians, we often underestimate the true burden of kidney disease in patients we commonly treat, including in the hospitalized setting.”
JOJohn OstrominskiCardiovascular medicine fellow, Brigham and Women's Hospital
“We know that heart and kidney health are highly interconnected, but management of heart and kidney disease remains relatively siloed, and kidney health often isn't prioritized in patients with heart disease until advanced stages. Declining kidney function is often asymptomatic until late in the disease course, but even less advanced stages of kidney impairment can have important implications for cardiovascular health.”
“We see this not infrequently, that in patients who have borderline kidney function, we often need to really engage with a whole other community, the nephrology community, to help manage them. In fact, we've had discussions at our institution of having dual clinics with cardiology and nephrology together because there are so many of these patients that we are managing today.”
Implication
Lower eGFR marks higher in-hospital mortality with less triple GDMT use; leaves open whether optimizing therapy improves outcomes in this observational cohort.
Cite This Study
Patel et al. (2021) conducted a cohort in Heart Failure (n=365,494). Kidney dysfunction (lower eGFR) vs. Higher eGFR (≥90 ml/min/1.73 m2) was evaluated on In-hospital mortality (p=<0.001). Lower admission eGFR in patients hospitalized with heart failure was associated with increased in-hospital mortality (up to 5.0%; p<0.001) and lower use of guideline-directed medical therapies.