Prognostic Impact of Cardiovascular‐Kidney‐Metabolic Overlap Among Patients With Acute Heart Failure: Insights From a Real‐World Multinational Cohort

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Background The prognostic significance of cardiovascular‐kidney‐metabolic (CKM) multimorbidity in acute heart failure (AHF) remains unclear. We evaluated its association with clinical outcomes in a real‐world, multinational cohort of patients with AHF. Methods We included patients with AHF hospitalized from 2005 to 2020 at 2 tertiary care centers in Switzerland and Kyrgyzstan. Patients were categorized based on the number of CKM conditions in addition to HF (0–3). CKM conditions included prior myocardial infarction, impaired kidney function (estimated glomerular filtration rate <60 mL/min/m 2 ), and diabetes. The association between the number of CKM conditions and the primary outcome of HF hospitalization or all‐cause death was assessed with Cox models. Results Among 1745 patients (69% Swiss, 44% female, age 74±13 years, left ventricular ejection fraction 43±16%), at baseline, 18.9% had HF alone, 39.0% had 1 CKM condition, 30.7% had 2, 11.4% had 3. Impaired kidney function was the most prevalent CKM condition (n=1011), followed by prior myocardial infarction (n=742) and diabetes (n=595). At 1 year, 731 patients (41.9%) experienced the primary outcome. Compared with HF alone, an increasing number of CKM conditions was associated with stepwise increases in the risk of the primary outcome (adjusted hazard ratios [HRs], 1.27 [95% CI, 1.01–1.59], 1.50 [95% CI, 1.19–1.89], and 2.10 [95% CI, 1.59–2.77] for 1, 2, and 3 CKM conditions). These associations remained consistent regardless of sex, age, and left ventricular ejection fraction ( P interaction >0.05 for all). Conclusions In this real‐world cohort of hospitalized patients with AHF, CKM multimorbidity was common and associated with a stepwise increase in the risk of adverse outcomes. These data underscore the importance of comprehensive CKM assessment in an AHF setting.

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