Cardiorenal Disease Pathways and Treatment of Patients With Comorbid Heart Failure and Chronic Kidney Disease

BACKGROUND: Heart failure (HF) and chronic kidney disease (CKD) are prevalent, interconnected chronic conditions that often coexist; however, real-world evidence describing the sequence of HF and CKD onset and the impact of disease progression sequence on HF guideline-directed medical therapy (GDMT) use is limited. OBJECTIVES: This real-world study aimed to investigate the chronological sequence of HF and CKD development (HF-first, CKD-first, or simultaneous HF and CKD diagnosis), patterns of outpatient specialist care, and HF GDMT use before and after the onset of both conditions. METHODS: This study used routinely collected health care data from electronic medical records, health care databases, and claims data from England (n = 63,752), Japan (n = 128,861), Sweden (n = 43,612), and the United States (n = 530,513). Patients (aged ≥18 years) were indexed at the date they first presented with comorbid HF and CKD (identified using diagnosis codes and/or estimated glomerular filtration rate measurements). RESULTS: In England and the United States, the most common disease progression pathway was CKD-first (58%-61% of patients), followed by HF-first (31%-35%), then simultaneous HF and CKD diagnosis (7%-8%). In the year before index, patients frequently had appointments with general practitioners (61%-100%), but rarely with nephrologists (4%-8%). In all 4 countries, use of HF GDMT was low before index and only mildly increased in the subsequent year. HF GDMT use was generally higher in patients in the HF-first pathway than in other progression pathways. CONCLUSIONS: This study provides insights into the real-world trajectory of cardiorenal disease, highlighting the need for proactive, coordinated, multidisciplinary disease management in this high-risk patient population.