In patients with new-onset heart failure, first-year cardiovascular hospitalization rates were higher in those with comorbid CKD (46.4 per 100 person-years) compared to HF alone (35.1).
Cohort (n=87,709)
Yes
In patients with new-onset heart failure, the presence of comorbid CKD, especially with T2D, is associated with significantly higher rates of hospitalisation and death, and unlike T2D alone, outcomes for those with CKD have not improved over the past 20 years.
Absolute Event Rate: 46.4% vs 35.1%
BACKGROUND: Heart failure (HF) together with type 2 diabetes (T2D) and chronic kidney disease (CKD) are major pandemics of the twenty first century. It is not known in people with new onset HF, what the distinct and combined associations are between T2D and CKD comorbidities and cause-specific hospital admissions and death, over the past 20 years. METHODS: ); (iii) T2D-only; (iv) T2D and CKD. CKD severity groups were: CKD-3a (eGFR 45-59); CKD-3b (30-44); CKD-4 (15-29); CKD-5 (<15). Outcomes were cardiovascular and non-cardiovascular hospitalisations and all-cause death. FINDINGS: In 87,709 HF patients (mean age, 78 years; 49% female), 40% had CKD-only, 12% T2D-only, and 16% both. Age-standardised first-year CVD hospitalisation rates were significantly higher in HF patients with CKD-only (46.4; 95% CI 44.9,47.9 per 100 person years) and T2D-only (49.2; 46.7,58.8) than in the reference group (35.1; 34.0,36.1); the highest rate was in patients with T2D-CKD-5: 89.1 (65.8,112.4). Similar patterns were observed for non-CVD hospitalisations and deaths. Group differences remained significant after adjustment for potential confounders. Median survival was highest in the reference (4.4 years) and HF-T2D-only (4.1 years) groups, compared to HF-CKD-only (2.2 years). HF-T2D-CKD group survival ranged from 2.8 (CKD-3a) to 0.7 years (CKD-5). Over time, CVD hospitalisation rates significantly increased for HF-CKD-only (+26%) and reduced (-24%) for HF-T2D-only groups; no reductions were observed in any of the HF-T2D-CKD groups. Trends were similar for non-CVD hospitalisations and death: whilst death rates significantly reduced for HF-T2D-only (-37%), improvement was not observed in any of the T2D-CKD groups. INTERPRETATION: In a cohort of people with new onset HF, hospitalisations and deaths are high in patients with T2D or CKD, and worst in those with both comorbidities. Whilst outcomes have improved over time for patients with HF and comorbid T2D, similar trends were not seen in those with comorbid CKD. Strategies to prevent and manage CKD in people with HF are urgently needed. FUNDING: NIHR fellowship reference: NIHR 30011.
Lawson et al. (Mon,) conducted a cohort in Heart failure, type 2 diabetes mellitus, and chronic kidney disease (n=87,709). Comorbid chronic kidney disease (CKD-only) vs. Heart failure without CKD or T2D (reference group) was evaluated on Age-standardised first-year cardiovascular hospitalisation rates (per 100 person years) (95% CI 44.9-47.9). In patients with new-onset heart failure, first-year cardiovascular hospitalization rates were higher in those with comorbid CKD (46.4 per 100 person-years) compared to HF alone (35.1).