Cardiovascular-Kidney-Metabolic Multimorbidity Linked to Higher Mortality and Readmission in Heart Failure

A retrospective cohort study in JAMA Cardiology examined cardiovascular-kidney-metabolic (CKM) overlap among 725,205 patients hospitalized for heart failure in the Get With The Guidelines–Heart Failure registry during 2019–2025. Researchers assessed four additional conditions: atherosclerotic cardiovascular disease, chronic kidney disease, diabetes, and obesity. Outcomes included in-hospital mortality and, among 123,271 Medicare beneficiaries hospitalized during 2019–2023, 1-year postdischarge mortality and heart failure readmission.

Overall, 521,739 patients (71.9%) had at least two additional CKM conditions; only 48,732 (6.7%) had none of the four. Overlap was greatest in heart failure with preserved ejection fraction (HFpEF). However, compared with heart failure alone, having all four conditions was associated with a larger increase in adjusted odds of in-hospital death in reduced-EF heart failure (HFrEF; odds ratio 5.08, 95% CI 4.43–5.83) than in mildly reduced-EF heart failure (2.37) or HFpEF (2.05).

Among Medicare beneficiaries with all four conditions, adjusted hazard ratios for 1-year mortality were 2.10 in HFrEF, 1.38 in mildly reduced-EF heart failure, and 1.09 in HFpEF. Corresponding hazard ratios for heart failure readmission were 2.33, 2.20, and 1.91. Risks increased stepwise with greater multimorbidity.

These findings highlight CKM burden as a prognostic marker across the EF spectrum, particularly in HFrEF. The retrospective observational design cannot establish causality, and postdischarge findings were limited to Medicare beneficiaries. Absolute event rates were not provided in the available abstract.