Circulation. Population health and outcomes · 2026
Optimizing Care in Cardiovascular-Kidney-Metabolic Syndrome: Registry Data From the Cardiometabolic Center Alliance.
СтатьяМногоцентровое исследованиеНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Neeland Ian J, Magwire Melissa L, Kwun Audrey, Aistrope Daniel S, Andaya Emily Ann Kapunan, Bashall Anthony, Benziger Catherine P, De Albuquerque Rocha Natalia, Butler Javed, Davis Lisa, Denicola Dawn, Eckel Robert H, Gosch Kensey, Harness Lacy, Helms Allyson R, Iluyomade Adedapo, Miller Keith A, Gianos Eugenia, Donahoe Sean, Patel Shachi, Plutzky Jorge, Stafos Andrea, Sauer Andrew J, Rajagopalan Sanjay, Kosiborod Mikhail N
Аннотация
BACKGROUND: Cardiovascular diseases (CVD) are leading causes of morbidity and mortality among patients with cardiovascular-kidney-metabolic syndrome. Adoption of guideline-directed medical therapy remains suboptimal. Our objective was to evaluate the impact of a team-based multisite care model on improving quality and reducing disparities in patients with cardiovascular-kidney-metabolic syndrome.
METHODS: We conducted a prospective clinical cohort study across 9 US sites of the Cardiometabolic Center Alliance, a network of health care organizations with a standardized approach to address CVD risk, between May 2020 and August 2024. Consecutive patients with type 2 diabetes/prediabetes and CVD and chronic kidney disease were enrolled in a clinical program with team care, structured visits, and standardized assessments. Cardiometabolic risk factor levels and proportion of adherence to guideline-directed medical therapy were assessed using longitudinal mixed-effects models accounting for clustering by site.
RESULTS: Two thousand two hundred twenty-three individuals were enrolled with a mean (SD) age of 63.9 (11.2) years, 44.2% female, 84.0% White, and 62.5% noncommercially insured; 58.5% had atherosclerotic CVD, 32.6% heart failure, and 29.5% chronic kidney disease. Median follow-up was 6.8 (4.0-9.4) months. Participants had reductions in weight (mean [95% CI], -16.7 [-17.9 to -15.6] lbs), body mass index (-2.6 [-2.8 to -2.4] kg/m2), systolic (-5.8 [-7.0 to -4.6] mm Hg) and diastolic (-1.7 [-2.4 to-0.9] mm Hg) blood pressure, total cholesterol (-26.4 [-29.5 to -23.2] mg/dL), low-density lipoprotein cholesterol (-18.8 [-21.4 to -16.2] mg/dL), triglycerides (-45.1 [-54.0 to -36.3] mg/dL), fasting glucose (-30.9 [-35.4 to -26.4] mg/dL), HbA1c (-1.2 [-1.3% to -1.0%]), and insulin dose (-30.4 [-36.1 to -24.8] units/d), P<0.001 for all. Guideline-directed medical therapy increased from 31.0% to 59.6% for atherosclerotic CVD type 2 diabetes and from 33.3% to 63.8% for chronic kidney disease type 2 diabetes, P<0.001.
CONCLUSIONS: The Cardiometabolic Center Alliance model is feasible and effective, leading to significant improvement in CVD risk factors and increased utilization of GDMT. Implementation and dissemination of this paradigm remains a priority to close gaps in cardiometabolic care.
METHODS: We conducted a prospective clinical cohort study across 9 US sites of the Cardiometabolic Center Alliance, a network of health care organizations with a standardized approach to address CVD risk, between May 2020 and August 2024. Consecutive patients with type 2 diabetes/prediabetes and CVD and chronic kidney disease were enrolled in a clinical program with team care, structured visits, and standardized assessments. Cardiometabolic risk factor levels and proportion of adherence to guideline-directed medical therapy were assessed using longitudinal mixed-effects models accounting for clustering by site.
RESULTS: Two thousand two hundred twenty-three individuals were enrolled with a mean (SD) age of 63.9 (11.2) years, 44.2% female, 84.0% White, and 62.5% noncommercially insured; 58.5% had atherosclerotic CVD, 32.6% heart failure, and 29.5% chronic kidney disease. Median follow-up was 6.8 (4.0-9.4) months. Participants had reductions in weight (mean [95% CI], -16.7 [-17.9 to -15.6] lbs), body mass index (-2.6 [-2.8 to -2.4] kg/m2), systolic (-5.8 [-7.0 to -4.6] mm Hg) and diastolic (-1.7 [-2.4 to-0.9] mm Hg) blood pressure, total cholesterol (-26.4 [-29.5 to -23.2] mg/dL), low-density lipoprotein cholesterol (-18.8 [-21.4 to -16.2] mg/dL), triglycerides (-45.1 [-54.0 to -36.3] mg/dL), fasting glucose (-30.9 [-35.4 to -26.4] mg/dL), HbA1c (-1.2 [-1.3% to -1.0%]), and insulin dose (-30.4 [-36.1 to -24.8] units/d), P<0.001 for all. Guideline-directed medical therapy increased from 31.0% to 59.6% for atherosclerotic CVD type 2 diabetes and from 33.3% to 63.8% for chronic kidney disease type 2 diabetes, P<0.001.
CONCLUSIONS: The Cardiometabolic Center Alliance model is feasible and effective, leading to significant improvement in CVD risk factors and increased utilization of GDMT. Implementation and dissemination of this paradigm remains a priority to close gaps in cardiometabolic care.