Introduction Heart failure (HF) and chronic kidney disease (CKD) have interlinked pathophysiological pathways and patients having both conditions simultaneously are defined as having cardiorenal syndrome (CRS). Purpose To estimate the risk of CRS in patients with initial presentation of HF (without prior CKD) or CKD (without prior HF) compared to mean age overall population in a real-world clinical setting. Also, to estimate the risk of all-cause death, cardiovascular (CV) death and non-fatal major CV events (MACE) in patients with HF, CKD and CRS compared to the mean-age overall population. Methods Clinical database analysis of a single primary and secondary healthcare institution from 2008–2019. We defined 4 incident cohorts: Control - patients at age 75; HF - HF patients without prior CKD; CKD - CKD patients without prior HF; CRS - patients with HF and CKD. Patients were indexed at the date of first event and followed one year. We defined HF as either: i) Ejection Fraction (EF)≤40% and NT-proBNP≥200pg/mL (≥600pg/mL if atrial fibrillation (AF)) OR BNP≥100pg/mL (≥125pg/mL if AF); ii) EF>40% in the presence of structural cardiac abnormalities. We defined CKD as eGFR≤60mL/min using EPI-CKD formula. All definitions were constructed using laboratory-level data complemented with episode-level data. Hazard ratios (HR) and 95% confidence intervals were estimated using Cox regression models adjusted for age, sex, age-sex interaction, prior history of hypertension, myocardial infarction, stroke, peripheral artery disease and type 2 diabetes. Results We identified 3973 patients with HF, 13990 with CKD, 6784 with CRS and 16182 controls. Patients were in general 75–77 years old. The majority were females and were well treated with CV risk reducing drugs (Table 1). All-cause death risk was 4.7 (4.1–5.2) for HF and 4.9 (4.5–5.4) for CKD. CV death risk was 8.6 (6.8–10.8) for HF and 8.7 (7.1–10.6) for CKD. Non-fatal MACE risk was 7.4 (6.3–8.7) for HF, 4.6 (4.0–5.3) for CKD, and 7.1 (6.1–8.3) for CRS. CRS was associated with the highest risks of all-cause and CV death when compared with the control group- 7.1 (6.4–7.9) and 13.7 (11.7–17.0), respectively (Figure 1). More than half of events occurred in the first 90 days of follow-up for all outcomes. Conclusions Cardiorenal disease (HF or CKD) was associated with very high short-term risk (1 year) of developing CRS or death. Consecutively, patients with established CRS had the highest risk of dying. These results demonstrate serious cardiorenal risks in a real-world setting, supporting an urgent need for improved primary and secondary prevention of cardiorenal disease and cardiorenal syndrome. Funding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): AstraZeneca Produtos Farmacêuticos, Lda. Table 1. Baseline characteristicsFigure 1. Outcomes for CKD, HF and CRS
Introduction Heart failure (HF) is a clinical syndrome caused by structural and functional cardiac abnormalities resulting in impairment of cardiac function, entailing significant morbi-mortality. HF is an age-dependent entity associated with cardiovascular (CV) risk factors such as type 2 diabetes (T2D). Purpose Estimate the prevalence of HF and its subtypes, and characterize HF in a population of integrated care users. Methods Non-interventional cross-sectional study performed in healthcare centre that provides primary and secondary care. All adult patients at 31/12/2019 were included. Echocardiographic parameters [left ventricle ejection fraction (LVEF) and evidence of structural heart disease] and elevated level of natriuretic peptides were used to define two HF phenotypes: i) HF with reduced ejection fraction (HFrEF, LVEF ≤40% and either NT-proBNP ≥400pg/mL (≥600pg/mL if atrial fibrillation (AF)/flutter) or BNP ≥100pg/mL (≥125pg/mL if AF/flutter)and ii) HF with non-reduced ejection fraction (HFnrEF), that encompasses both HFpEF (LVEF ≥50% and either NT-proBNP ≥200pg/mL (≥600pg/mL if AF/flutter) or BNP ≥100pg/mL (≥125pg/mL if AF/flutter) in the presence of at least one structural cardiac abnormality) and HF mid-range ejection fraction (HFmEF, LVEF within ]40, 50% [and either NT-proBNP ≥200pg/mL (≥600pg/mL if AF/flutter) or BNP ≥100pg/mL (≥125pg/mL if AF/flutter) in the presence of at least one structural cardiac abnormality). The significance threshold was set at P≤0.001. Results We analysed 126636 patients with mean age of 52.2 (SD=18.3) years, 57% (N=72290) were female. The prevalence of HF was 2.1% (N=2700). HF patients mean age was 74.0 (SD=12.1) years and 51.6% (N=1394) were female. Regarding HF subtypes, HFpEF accounted for 65.4% (N=1765), 16.1% (N=434) had HFmEF and 16.3% (N=439) had HFrEF. Patients with HFrEF were younger (P<0.001) and had a history of myocardial infarction more frequently (P<0.001) comparing to HFnrEF, with no other significant differences between HF groups. HFrEF patients were more frequently prescribed CV medications than HFnrEF patients, namely antiplatelet agents, ACE inhibitors (55.6% vs 32.7%, P<0.001), beta blockers (79.3 vs 55.8%, P<0.001) and aldosterone receptor antagonists (48.7 vs 8.3%, P<0.001). T2D was present in 44.7% (N=1207) of HF patients. CKD was more frequently present in T2D vs non-T2D HF patients at every stage (P<0.001) as well as stroke, peripheral artery disease and microvascular disease (P<0.001) (Table 1). Conclusions In this cohort, considering a contemporary definition, HF prevalence was 2.1%; HFrEF accounted for 16.3% of cases, with similar clinical-epidemiological profile previously reported in the literature. Our study revealed a high prevalence of patients with HFpEF (65.4%), raising awareness for the increasing prevalence of this entity in cardiology practice. These results may guide local and national health policies and strategies for HF diagnosis and management. Funding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): AstraZeneca, Produtos Farmacêuticos Lda Table 1. HF Patient Characteristics by subtype
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