Cardiorenal unit in advanced cardiorenal disease: Clinical impact and reduction of hospital costs

Abstract

Background and objective: Cardiorenal syndrome (CRS) reflects a bidirectional interaction between heart failure (HF) and chronic kidney disease (CKD), with high associated healthcare costs. Hospitalizations due to cardiovascular (CV) events, particularly for decompensated HF, represent most CKD-related costs. Cardiorenal units (CRU) emerge as an innovative strategy to address this complexity through a multidisciplinary approach. This study analyses the effectiveness and efficiency of CRUs. Material and methods: Observational, longitudinal, prospective, and single-centre study using an adapted interrupted time-series design. Patients with advanced CKD (eGFR < 30 ml/min/1.73 m2 ) and HF with reduced left ventricular ejection fraction (LVEF) were included. Clinical, demographic, and care-related data were analysed during the year before and the year after enrollment. Economic costs were derived from healthcare resource consumption associated with hospital care activities. Results: In 55 patients (mean age 73.9 ± 8.6 years; 78% male), a 65% reduction in emergency department visits (p = 0.0001) and a 60.5% reduction in hospitalizations (p = 0.0015) were observed. The economic analysis revealed cost savings of approximately €700,000, with an average reduction of almost €13,000 per patient/year. After inclusion in the CRU, there was an increased prescription of prognostic drugs, with no significant changes in serum potassium concentration (p = 0.26) and no evidence of renal function deterioration (pre-vs. post-eGFR: 23.36 ± 7.6 mg/dl vs. 22.44 ± 8.5 mg/dl; p = 0.17). A significant differential impact was observed in all healthcare outcomes, particularly among patients receiving quadruple therapy. Conclusion: CRUs emerge as effective and efficient models for the management of cardiorenal syndrome. Randomized controlled studies are needed to validate these findings and optimize healthcare policies.

Antecedentes y objetivo: El síndrome cardiorrenal (SCR) refleja una interaccion bidireccional entre la ́ insuficiencia cardíaca (IC) y la enfermedad renal cronica (ERC), con altos costes asistenciales asociados. Las ́ hospitalizaciones por eventos cardiovasculares (CV), particularmente por IC descompensada, representan el coste mayoritario de la ERC. Las unidades cardiorrenales (UCR) surgen como una estrategia innovadora para abordar esta complejidad mediante un enfoque multidisciplinar. Este estudio analiza la efectividad y la eficiencia de las UCR. Materiales y metodos: ́ Estudio observacional, longitudinal, prospectivo y unicentrico utilizando un diseño ́ adaptado de series temporales interrumpidas. Se incluyeron pacientes con ERC avanzada (TFGe < 30 mL/ min/1.73 m2 ) e IC con fraccion de eyeccio ́ n del ventrículo izquierdo (FEVI) reducida. Se analizaron datos ́ clínicos, demográficos y asistenciales durante el año previo y el año posterior a la inclusion. El coste ́ economico se obtuvo a partir del consumo de recursos sanitarios asociados a la actividad asistencial ́ hospitalaria. Resultados: En 55 pacientes (edad media 73,9 ± 8,6 años; 78% varones) se observóun descenso del 65% en visitas a urgencias (p = 0,0001) y del 60,5% en hospitalizaciones (p = 0,0015). Se evidencióun ahorro de costes cercano a 700.000 €, una reduccion promedio de casi 13.000 ́ € por paciente/año. Hubo una mayor prescripcion de fármacos prono ́ sticos tras ser incluidos en la UCR, sin cambios en la concentracio ́ n se ́ rica de ́ potasio (p = 0,26) y sin objetivar empeoramiento de la funcion renal (TFGe pre vs post: ́ 23,36 ± 7.6 mg/dL vs 22,44 ± 8.5 mg/dL; p = 0,17). Se logró un impacto diferencial significativo en todos los resultados asistenciales en aquellos bajo tratamiento con cuádruple terapia. Conclusiones: Las UCR destacan como modelos efectivos y eficientes en la atencion del SCR. Se necesitan ́ estudios aleatorizados y controlados que validen estos hallazgos y optimicen las políticas sanitarias.