Application of the American Heart Association/American College of Cardiology/Heart Failure Society of America Heart Failure Staging Guidelines in Adults With Chronic Kidney Disease
Background In 2022 the American Heart Association/American College of Cardiology/Heart Failure Society of America Guidelines for Management of Heart Failure proposed an updated staging system with cardiac biomarkers to diagnose heart failure (HF) and its severity. The applicability of this staging s...
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Wiley
2025-07-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
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| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.124.039868 |
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| author | Anna M. Zemke Leila R. Zelnick Joachim H. Ix Alan S. Go Edward D. Siew Nisha Bansal |
| author_facet | Anna M. Zemke Leila R. Zelnick Joachim H. Ix Alan S. Go Edward D. Siew Nisha Bansal |
| author_sort | Anna M. Zemke |
| collection | DOAJ |
| description | Background In 2022 the American Heart Association/American College of Cardiology/Heart Failure Society of America Guidelines for Management of Heart Failure proposed an updated staging system with cardiac biomarkers to diagnose heart failure (HF) and its severity. The applicability of this staging system in chronic kidney disease is not well established. Methods This is a prospective cohort study of 2415 participants from CRIC (Chronic Renal Insufficiency Cohort). Individuals were classified into HF stages using 2013 and 2022 American Heart Association/American College of Cardiology/Heart Failure Society of America HF guidelines using research echocardiograms, cardiac biomarkers (troponin T ≥10 ng/L [women], ≥15 ng/L [men], pro‐B‐type natriuretic peptide ≥125 pg/mL), laboratory measures, and history. Adjudicated outcomes of HF hospitalizations and all‐cause mortality are reported. Results In individuals with chronic kidney disease, participants with lower estimated glomerular filtration rates were more likely to be reclassified to a more advanced HF stage using the current proposed thresholds of hsTNT (high‐sensitivity troponin T) and NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide). The 2022 guidelines reclassified 55% of 2013 guideline stage A participants to stage B. HF hospitalization incidence rates differed when individuals were categorized into stage B HF based on elevated hsTNT or NT‐proBNP (1.7 per 100 person‐years) compared with echocardiographic abnormalities (2.9 per 100 person‐years), whereas death rates were similar between these groups. Conclusions Among individuals with CKD, the addition of elevated hsTNT or NT‐proBNP to HF staging reclassified nearly 20% of total participants into a higher HF stage. These individuals had similar mortality rates to those previously in higher stages, but they had lower HF hospitalization rates. Those with more advanced chronic kidney disease were more likely to be reclassified. |
| format | Article |
| id | doaj-art-5b948ea2b7f84ed39d7e0be4220feabf |
| institution | Kabale University |
| issn | 2047-9980 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-5b948ea2b7f84ed39d7e0be4220feabf2025-08-20T03:50:49ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802025-07-01141410.1161/JAHA.124.039868Application of the American Heart Association/American College of Cardiology/Heart Failure Society of America Heart Failure Staging Guidelines in Adults With Chronic Kidney DiseaseAnna M. Zemke0Leila R. Zelnick1Joachim H. Ix2Alan S. Go3Edward D. Siew4Nisha Bansal5Kidney Research Institute, Division of Nephrology University of Washington Seattle WA USAKidney Research Institute, Division of Nephrology University of Washington Seattle WA USADivision of Nephrology‐Hypertension, Department of Medicine University of California San Diego San Diego CA USADivision of Research Kaiser Permanente Northern California Pleasanton CA USADivision of Nephrology and Hypertension, Department of Medicine Vanderbilt University Medical Center Nashville TN USAKidney Research Institute, Division of Nephrology University of Washington Seattle WA USABackground In 2022 the American Heart Association/American College of Cardiology/Heart Failure Society of America Guidelines for Management of Heart Failure proposed an updated staging system with cardiac biomarkers to diagnose heart failure (HF) and its severity. The applicability of this staging system in chronic kidney disease is not well established. Methods This is a prospective cohort study of 2415 participants from CRIC (Chronic Renal Insufficiency Cohort). Individuals were classified into HF stages using 2013 and 2022 American Heart Association/American College of Cardiology/Heart Failure Society of America HF guidelines using research echocardiograms, cardiac biomarkers (troponin T ≥10 ng/L [women], ≥15 ng/L [men], pro‐B‐type natriuretic peptide ≥125 pg/mL), laboratory measures, and history. Adjudicated outcomes of HF hospitalizations and all‐cause mortality are reported. Results In individuals with chronic kidney disease, participants with lower estimated glomerular filtration rates were more likely to be reclassified to a more advanced HF stage using the current proposed thresholds of hsTNT (high‐sensitivity troponin T) and NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide). The 2022 guidelines reclassified 55% of 2013 guideline stage A participants to stage B. HF hospitalization incidence rates differed when individuals were categorized into stage B HF based on elevated hsTNT or NT‐proBNP (1.7 per 100 person‐years) compared with echocardiographic abnormalities (2.9 per 100 person‐years), whereas death rates were similar between these groups. Conclusions Among individuals with CKD, the addition of elevated hsTNT or NT‐proBNP to HF staging reclassified nearly 20% of total participants into a higher HF stage. These individuals had similar mortality rates to those previously in higher stages, but they had lower HF hospitalization rates. Those with more advanced chronic kidney disease were more likely to be reclassified.https://www.ahajournals.org/doi/10.1161/JAHA.124.039868cardiac biomarkerschronic kidney diseaseheart failurehospitalizationsmortality |
| spellingShingle | Anna M. Zemke Leila R. Zelnick Joachim H. Ix Alan S. Go Edward D. Siew Nisha Bansal Application of the American Heart Association/American College of Cardiology/Heart Failure Society of America Heart Failure Staging Guidelines in Adults With Chronic Kidney Disease Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease cardiac biomarkers chronic kidney disease heart failure hospitalizations mortality |
| title | Application of the American Heart Association/American College of Cardiology/Heart Failure Society of America Heart Failure Staging Guidelines in Adults With Chronic Kidney Disease |
| title_full | Application of the American Heart Association/American College of Cardiology/Heart Failure Society of America Heart Failure Staging Guidelines in Adults With Chronic Kidney Disease |
| title_fullStr | Application of the American Heart Association/American College of Cardiology/Heart Failure Society of America Heart Failure Staging Guidelines in Adults With Chronic Kidney Disease |
| title_full_unstemmed | Application of the American Heart Association/American College of Cardiology/Heart Failure Society of America Heart Failure Staging Guidelines in Adults With Chronic Kidney Disease |
| title_short | Application of the American Heart Association/American College of Cardiology/Heart Failure Society of America Heart Failure Staging Guidelines in Adults With Chronic Kidney Disease |
| title_sort | application of the american heart association american college of cardiology heart failure society of america heart failure staging guidelines in adults with chronic kidney disease |
| topic | cardiac biomarkers chronic kidney disease heart failure hospitalizations mortality |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.124.039868 |
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