https://doi.org/10.1007/s00392-025-02737-x
1Deutsches Herzzentrum der Charite (DHZC) Klinik für Kardiologie, Angiologie und Intensivmedizin Berlin, Deutschland; 2BioStats GmbH Statistical Consulting Nauen, Deutschland
Introduction
Heart Failure with Preserved Ejection Fraction (HFpEF) represents half of all Heart Failure cases, but early disease detection remains challenging (1–3). As a result, many cases go undetected and treatment initiation is delayed, potentially worsening patient outcomes and increasing the healthcare burden [4].
Chronic Kidney Disease (CKD) shares similar risk factors with HFpEF and is common in this population (4). Further, CKD is associated with worse outcomes in HFpEF patients(5,6). Some data also links CKD with higher rates of incident heart failure(4).
This study investigates the prevalence of undiagnosed HFpEF in a population with CKD and risk factors for HFpEF.
Method
The Screen CardRen study enrolled subjects with an CKD Stage G3-4 and A2-3 at screening and at least one of the following cardiovascular (CV) risk factors: arterial hypertension, hyperlipidemia, diabetes mellitus. Exclusion criteria comprised a prior diagnosis of heart failure, end stage renal disease and recent acute CV events. HFA-PEFF score was calculated as described earlier for each patient (3). Clinical, laboratory and echocardiographic data was collected and compared between the risk groups.
Results
In a subset analysis, according to the HFA-PEFF score N = 36 (35.3%), N = 51 (50.0%), N = 15 (14.7%) had a high, undetermined or low risk for HFpEF, respectively. In comparison, the high-risk group was older, had worse albuminuria and showed a higher prevalence of atrial fibrillation (table 1). After correcting for age and sex, HFA-PEFF score was associated with an increased risk for albuminuria (OR 1.48 95% CI, 1.12 – 2.03), p = 0.008, figure 1). Finally, N = 8 (21.9%) of the high-risk group were treated with SGLT2 inhibitors.
Conclusion
Our findings show that, using the HFA-PEFF score, a substantial proportion of patients with CKD and CV risk factors are at risk for undiagnosed HFpEF. Moreover, less than a quarter of these patients receive specific treatment. Further investigation into early detection of HFpEF and CKD overlap cases may aid in early disease diagnosis and timely treatment initialization, leading to a reduction in disease burden of HFpEF.
1. doi: 10.1093/eurheartj/ehab368
2. doi: 10.1161/CIRCULATIONAHA.119.041886
3. doi: 10.1093/eurheartj/ehz641
4. doi: 10.1016/j.hfc.2008.03.008
5. doi: 10.1016/j.jacc.2022.10.028
6. doi: 10.1161/CIRCHEARTAILURE.123.011173
2. doi: 10.1161/CIRCULATIONAHA.119.041886
3. doi: 10.1093/eurheartj/ehz641
4. doi: 10.1016/j.hfc.2008.03.008
5. doi: 10.1016/j.jacc.2022.10.028
6. doi: 10.1161/CIRCHEARTAILURE.123.011173