Optimizing Care in Cardiovascular-Kidney-Metabolic Syndrome: Registry Data From the Cardiometabolic Center Alliance.

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.