Among 2,468 heart failure patients, the 10.7% with advanced CKD had higher disease severity but significantly lower utilization of cardiac rehabilitation programs (5.9% vs 10.2%; p=0.041).
Observational (n=2,468)
Yes
How do clinical characteristics and treatment utilization differ between heart failure patients with advanced chronic kidney disease (GFR ≤30) and those with GFR >30?
Heart failure patients with advanced chronic kidney disease have greater disease severity but receive significantly less guideline-directed medical therapy compared to those with better renal function.
Absolute Event Rate: 5.9% vs 10.2%
p-value: p=0.041
Abstract Introduction Heart failure (HF) is a serious health problem and continues to have a high mortality and incidence of decompensation, despite advances in its management. Chronic kidney disease (CKD) is very prevalent in patients with HF, hinders their treatment and worsens their prognosis, especially when it is advanced CKD (glomerular filtration rate-GFR ≤30 ml/min/m2). It is important to know the differential characteristics of these patients to improve their management. Purpose To analyze in a contemporary registry of HF patients followed in specialized HF units in Spain the differences in clinical characteristics and treatment between patients with HF and advanced CKD. Methods We analyzed data from the registry of the SEC-Excelente-IC quality accreditation program of the Spanish Society of Cardiology, with 2,468 patients with HF included between 2019 and 2024 by 68 specialized HF units. Patients were included consecutively in two 1-month cutoffs (March and October) in that period. The clinical and demographic characteristics and comorbidities of the patients, as well as their treatment, were compared between GFR ≤ or 30ml/min/m2 subgroups. Results Of the 2,468 patients, 10.7% had a GFR≤30 and 89.3% 30 mL/min/m2. Figure 1 shows the main clinical characteristics and comorbidities of the 2 groups. Patients with advanced CKD were older (76.9±9.6 versus 70.5±12.3 years, p0.001), had greater HF severity (more admissions for HF in the last year, worse NYHA functional class and longer evolution time), and a higher prevalence of coronary heart disease, hypertension, diabetes mellitus, cognitive impairment, anemia, iron deficiency and hyponatremia. There were no differences in HF type (reduced, mildly reduced or preserved LVEF), sex, BMI, serum potassium or other comorbidities (Figure 1). Figure 2 shows the treatment received in each group. Patients with GFR≤30 received in a significantly lower proportion ACEI/ARB, sacubitril-valsartan, MRA, beta-blockers, digoxin and SLGT2 inhibitors, but more diuretics and potassium binders), and less cardiac rehabilitation programs (5.9 vs 10.2%; p=0.041). Conclusions In our contemporary cohort of real-life HF patients, the prevalence of advanced CKD was 10.7%. These patients had a higher severity of HF, despite which, the utilization of HF drugs, including sacubitril-valsartan and SGLT2 inhibitors was significantly lower than in those with GFR 30 ml/min/m2. This trend needs to be modified to improve the prognosis of these patients.Main clinical features of our patients Treatment according to renal function
Gámez et al. (Sat,) conducted a observational in Heart failure and advanced chronic kidney disease (n=2,468). Advanced CKD (GFR ≤30 ml/min/m2) vs. GFR >30 ml/min/m2 was evaluated on Participation in cardiac rehabilitation programs (p=0.041). Among 2,468 heart failure patients, the 10.7% with advanced CKD had higher disease severity but significantly lower utilization of cardiac rehabilitation programs (5.9% vs 10.2%; p=0.041).
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