Heart failure & cardiomyopathiesCohort study
Cardiovascular-Kidney-Metabolic Overlap in Patients Hospitalized for Heart Failure
- Retrospective cohort study
- Get With The Guidelines-Heart Failure (GWTG-HF) registry
Authors' conclusion
In this contemporary cohort of US patients hospitalized for HF, most patients had multiple additional overlapping CKM conditions. Increasing CKM multimorbidity was independently associated with stepwise increases in mortality and readmission risk. Although these associations spanned the EF spectrum, the prognostic impact of CKM multimorbidity was greatest in HFrEF and least in HFpEF.
Study context
- Population
- Patients hospitalized for heart failure (HF) at US hospitals in the GWTG-HF registry (2019–2025) and Medicare beneficiaries (2019–2023), across the ejection fraction (EF) spectrumplus 123,271 Medicare beneficiaries
- Participants
- 725,205 patients
- Exposure
- Number of overlapping cardiovascular-kidney-metabolic (CKM) conditions vs HF only
- HF onlyn = 48,732reference
- Outcome
- In-hospital mortality, 1-year postdischarge all-cause mortality, and 1-year postdischarge HF readmission
Main finding
As reported in the abstract
In-hospital mortality, 4 CKM conditions vs HF only
4 CKM conditions vs HF onlyAdjusted odds ratio (95% CI)
HFrEF
5.08(4.43–5.83)
HFmrEF
2.37(1.68–3.34)
HFpEF
2.05(1.77–2.38)
Observational data: associations, not effects.
Further findings
| Outcome | aHR (95% CI) | |
|---|---|---|
| Postdischarge all-cause mortality, 4 CKM conditions vs HF only (Medicare) · 1 year — 4 CKM conditions vs HF only · HFrEF | 2.10 (1.93–2.29) | |
| Postdischarge all-cause mortality, 4 CKM conditions vs HF only (Medicare) · 1 year — 4 CKM conditions vs HF only · HFmrEF | 1.38 (1.17–1.63) | |
| Postdischarge all-cause mortality, 4 CKM conditions vs HF only (Medicare) · 1 year — 4 CKM conditions vs HF only · HFpEF | 1.09 (1.03–1.17) | |
| HF readmission, 4 CKM conditions vs HF only (Medicare) · 1 year — 4 CKM conditions vs HF only · HFrEF | 2.33 (2.12–2.56) | |
| HF readmission, 4 CKM conditions vs HF only (Medicare) · 1 year — 4 CKM conditions vs HF only · HFmrEF | 2.20 (1.82–2.66) | |
| HF readmission, 4 CKM conditions vs HF only (Medicare) · 1 year — 4 CKM conditions vs HF only · HFpEF | 1.91 (1.77–2.06) | |
| 0.20.5125Adjusted hazard ratio (log scale) |
- Postdischarge all-cause mortality, 4 CKM conditions vs HF only (Medicare): P for interaction <.001
- HF readmission, 4 CKM conditions vs HF only (Medicare): P for interaction <.001
Prevalence of ≥2 overlapping CKM conditions
- ≥2 overlapping CKM conditions
- 521 739 (71.9%)
- HF only
- 48 732 [6.7%]
- CKM overlap greatest in HF with preserved EF (HFpEF)
Original publication
Cardiovascular-Kidney-Metabolic Overlap in Patients Hospitalized for Heart Failure. JAMA Cardiol. Published 30 September 2026. doi:10.1001/jamacardio.2026.4215
Summarised from the published abstract; every number is checked against it