Researchers from Brigham and Women’s Hospital, a founding Mass General Brigham healthcare system member, have uncovered significant links between heart failure and kidney disease, prompting innovative approaches to integrate care for these interconnected conditions. Their study analysed data from over 85,000 adults aged 65 and older hospitalised for heart failure across 372 sites in the U.S. Published in JAMA Cardiology, the research revealed a substantial risk of kidney complications, with approximately 6 per cent of patients progressing to dialysis within one year of hospitalisation.
Dr. John Ostrominski, MD, a fellow in Cardiovascular Medicine and Obesity Medicine at the Brigham, highlighted the current compartmentalisation of heart and kidney disease management despite their profound interplay. He emphasised the often asymptomatic nature of declining kidney function, underscoring its critical implications for cardiovascular health. The study advocates for comprehensive analyses to assess kidney outcomes in heart failure patients, aiming to reshape clinical approaches.
Despite approximately two-thirds of older adults with heart failure showing abnormal kidney function, few studies have examined critical kidney outcomes such as acute kidney injury hospitalisations or the need for dialysis. By focusing on these patient-centred outcomes, the research suggests the potential for transformative changes in how heart and kidney diseases are managed together in clinical practice.
The study drew on Medicare claims data to reveal that 63 per cent of discharged patients had significantly impaired kidney function, as measured by filtration rate. It also found a stark escalation in adverse kidney outcomes among those with lower kidney function, with 6 per cent requiring dialysis and 7 per cent progressing to end-stage kidney disease within a year post-discharge.
These findings underscore the need for cardiologists to prioritise assessing kidney function in heart failure patients, including regular filtration rate assessments and screening for albuminuria. The study proposes integrating kidney health considerations into cardiovascular care metrics and expanding Medicare reimbursement for interdisciplinary chronic care management, suggesting systemic changes to enhance patient outcomes.
In addition to clinical insights, the research advocates for broader policy and institutional changes to support simultaneous management of heart and kidney diseases. This includes establishing integrated care clinics, advancing clinical trial efforts to evaluate new treatment strategies, and leveraging existing healthcare frameworks to deliver comprehensive, patient-centred care.
Dr Ostrominski emphasised that while the study’s findings align with existing knowledge on heart-kidney health interactions, its significance lies in providing actionable insights to improve clinical outcomes for heart failure patients. He highlighted critical opportunities at various levels – from individual patient care to healthcare policy – to substantially improve managing these complex health challenges.
More information: John W. Ostrominski et al, Kidney Outcomes Among Medicare Beneficiaries After Hospitalization for Heart Failure, JAMA Cardiology. DOI: 10.1001/jamacardio.2024.1108
Journal information: JAMA Cardiology Provided by Brigham and Women’s Hospital
