Cardiovascular-Kidney-Metabolic Overlaps, Clinical Outcomes, and Medications Among Patients With Heart Failure: Results From the Chinese Cardiovascular Association Database-Heart Failure Center Registry.

Cardiovascular-kidney-metabolic (CKM) multimorbidity is common among patients with heart failure (HF), but its prognostic impact in Chinese patients remains largely unclear. We examined the relationship of CKM multimorbidity with adverse outcomes and its interaction with guideline-directed medical therapy (GDMT) in patients with HF. We classified hospitalized patients with HF by CKM-condition count (atherosclerotic cardiovascular disease [ASCVD], chronic kidney disease [CKD], and type 2 diabetes [T2D]). Cox models assessed 1-year all-cause death, cardiovascular (CV) death, and rehospitalizations. Among patients with HF with reduced ejection fraction (HFrEF), subgroup analyses were conducted by GDMT use. Among 126,524 patients, 66.4% had at least one CKM condition and 5.1% had all three. All-cause death increased with CKM burden; three conditions conferred the highest risk (adjusted hazard ratio 2.43, 95% confidence interval [CI] 2.20-2.69) versus no CKM conditions. Associations were stronger in HFrEF. Although GDMT recipients had lower absolute death rates, associations of CKM multimorbidity with all outcomes were generally consistent regardless of GDMT use. CKM multimorbidity is common in Chinese patients hospitalized with HF and is associated with a worse prognosis. Although GDMT lowered absolute death rates, it did not substantially modify the relative associations between CKM multimorbidity and subsequent clinical outcomes.