Impact of Chronic kidney Disease on Utilization of Coronary Angiography and Revascularization in Patients Hospitalized with New-onset Heart Failure

Background
Chronic kidney disease (CKD) is an independent risk factor for coronary artery disease (CAD). Despite CAD being a common etiology of heart failure (HF), there is paucity of data in the rate of coronary angiography and revascularization in patients with new onset HF and CKD.

Methods
This was a retrospective cohort study of 950 consecutive patients enrolled in Get With The Guidelines-HF registry and admitted with new-onset HF to a tertiary care center between 2007 and 2016. CKD was defined as estimated GFR of < 60 ml/min/1.73m,²based on MDRD equation, while non-CKD was defined as estimated GFR ³60 ml/min/1.73m². The rates of angiography and revascularization were evaluated in patients with (n=551) and without CKD (n=399). Multivariate analysis was performed to assess the independent effect of CKD on 30-day HF readmission rate.

Results
Mean age for the entire cohort was 65.6±15.9; 61.8% were male, 77.7% were Caucasian and 58% had CKD. Compared to non-CKD group, CKD patients were older (71 vs 63 years), Caucasians (82.0% vs 70.7%), with higher prevalence of diabetes (42.6% vs 33.3%), hypertension (72.9% vs 65.1%), hyperlipidemia (49.7% vs 38.3%), CAD (50.5% vs 36.6%), tobacco use (83.7% vs 75.2%), and HF with ejection fraction <40% (53.3% vs 46.6%). All p values were <0.001.

Patients with CKD had a lower rate of coronary angiography (6.7 % vs 10.8%, p=0.027), but a higher rate of subsequent revascularization (2.7% vs 0.5%, p=0.021) and 30-day readmission (27.4 % vs 21.1%, p=0.025) compared to patients without CKD. On multivariate analysis, presence of CKD independently increased the 30-day readmission rate (adjusted OR 1.4, 95%CI 1.03 -1.95, p=0.028).

Conclusions
In this cohort of patients with new-onset HF, CKD patients were less likely to undergo invasive ischemic evaluation in comparison to patients without CKD. However, patients with CKD required revascularization more often, and had higher subsequent 30-day HF readmission rate. These findings imply the importance of proper ischemia evaluation and revascularization in patients with new-onset HF and CKD.