Implementation Barriers to Evidence-Based Cardiovascular-Kidney-Metabolic Syndrome Management

Cardiovascular-kidney-metabolic (CKM) syndrome is a newly defined health syndrome, encompassing the overlapping pathophysiology and risk factors of cardiovascular and kidney disease, obesity, and type 2 diabetes. It is the leading cause of morbidity and mortality worldwide, with an annual health cost of approximately AUD 24 billion in Australia alone. A disproportionate burden is observed among those with adverse social determinants of health. Despite compelling evidence demonstrating improved metabolic risk factors and reduced risk of kidney failure and cardiovascular events, uptake of traditional and novel cardio-kidney metabolic therapies, including sodium-glucose cotransporter 2 inhibitors, glucagon-like peptide-1 receptor agonists, and non-steroidal mineralocorticoid receptor antagonists, remains low. This delay underscores many challenges to optimal CKM syndrome care, including system barriers such as public health policy, siloed health care, and inequitable access to pharmacotherapies; provider barriers, including lack of awareness and clinical inertia; and patient barriers such as social determinants of health. A global shift in the approach to healthcare that focuses on multidimensional, multidisciplinary care and provision of pharmacotherapies in patient groups most at risk is required to change the trajectory of this public health emergency.