Cardio-kidney-metabolic overlap in patients with severe heart failure: data from the HELP-HF registry
A Villaschi, D Pini, D Stolfo, L Baldetti, C M Lombardi, M Adamo, D Tomasoni, R M Inciardi, A M Cappelletti, G Condorelli, M Merlo, G Sinagra, M Metra, M Pagnesi, M ChiaritoAbstract
Background
Cardiovascular, kidney, and metabolic (CKM) conditions frequently coexist in patients with heart failure (HF), compounding their risk. However, their prevalence and prognostic impact in patients with severe HF remain underexplored.
Objectives
To evaluate the impact of CKM overlap in patients with severe HF.
Methods
We included 1149 patients enrolled in the multicenter HELP-HF registry, which includes individuals with severe HF identified by "I NEED HELP" markers. CKM conditions were assessed across three domains: atherosclerotic cardiovascular disease (ASCVD), chronic kidney disease (CKD) (eGFR <60 mL/min/1.73 m2), and metabolic disorders (obesity or type 2 diabetes). Patients were grouped by number of CKM conditions (0–3). The primary endpoint was a composite of 1-year all-cause death or HF hospitalization. Secondary endpoints included all-cause death, cardiovascular death, and first HF hospitalization.
Results
CKM conditions were highly prevalent: 85.5% of patients had at least one condition, and 22.3% had all three conditions. ASCVD was the most common (58.7%), followed by CKD (56.5%) and metabolic disorders (48.9%). An increasing number of CKM conditions was associated with worse outcomes, even after multivariable adjustment. The risk of the primary endpoint increased progressively with each additional CKM condition (1: HR 1.92, 95% CI 1.33-2.78; 2: HR 2.11, 95% CI 1.47-3.02; 3: HR 2.52, 95% CI 1.74-3.65; all p<0.001 vs. 0 conditions), with similar trends for its individual components.
Conclusions
CKM overlap is highly prevalent among patients with severe HF and is independently associated with worse clinical outcomes. These findings underscore the importance of CKM profiling in HF risk stratification.For image description, please refer to the figure legend and surrounding text.