Adverse cardiovascular and renal outcomes in heart failure patients: a prospective cohort from a community heart failure unit (2022–2024)
M Barrantes-Castillo, M Barreda Santa Cruz, S Liano de Sola, D Robledillo MorenoAbstract
Background
Major adverse cardiovascular events (MACE) and major adverse renal events (MARE) are the main complications of heart failure (HF) and substantially increase morbidity and mortality. The bidirectional cardiorenal interaction worsens the prognosis of both conditions. Data on independent predictors of composite cardiorenal outcomes in real-world heart failure unit (HFU) populations remain scarce.
Purpose
To characterise adverse cardiovascular and renal outcomes in HF patients followed in a community HFU and to identify independent predictors of a composite cardiorenal endpoint (first MACE or MARE).
Methods
Single-centre prospective cohort study including 341 HF patients (60.1% reduced ejection fraction [HFrEF], 13.5% mildly reduced, 26.4% preserved) followed in an HFU (March 2022–March 2024; median follow-up 12.7 months, IQR 8.6–17.1). Primary outcome: time to first composite cardiorenal event (MACE or MARE). Statistical methods: descriptive statistics with Wilson 95% CIs; bivariate analyses with Benjamini–Hochberg correction; Kaplan–Meier curves; multivariable Cox regression; multivariable logistic regression with internal validation (500-replicate bootstrap and 10-fold cross-validation); propensity score methods (IPTW and PS-matching) for treatment effect assessment.
Results
Over median 12.7-month follow-up, 106 patients (31.1%) experienced the composite endpoint: 35.8% cardiovascular-first, 64.2% renal-first. All-cause mortality: 10.3%. Five independent predictors in the multivariable Cox model (C-index=0.833): baseline chronic kidney disease (HR=2.56, 95%CI 1.47–4.44; p=0.0008), prior renal event (HR=2.50, 1.59–3.93; p=0.0001), prior HF hospitalisation (HR=1.80, 1.18–2.74; p=0.006), atrial fibrillation (HR=1.78, 1.12–2.83; p=0.015) and NT-proBNP (HR=1.40 per log-unit, 1.08–1.83; p=0.012). The logistic model confirmed these findings (AUC=0.884; optimism-corrected AUC=0.863; cross-validated AUC=0.853). eGFR showed a dose-response gradient: event rate 7.1% (eGFR ≥90) to 71.4% (eGFR 15–29 ml/min/1.73 m²; OR=32.5). Only 18.8% received optimised four-pillar therapy; no drug showed a significant protective effect after propensity score adjustment.
Conclusion
Adverse cardiorenal outcomes affected 31.1% of HF patients, with renal events predominating as first manifestation. Baseline chronic kidney disease and reduced eGFR showed a marked dose-response relationship with event risk. A five-variable model demonstrated excellent discrimination and robust internal validation. These findings support systematic cardiorenal risk stratification in HFUs to optimise management and resource allocation.