Introduction: The American Heart Association recognizes the interrelated burden of obesity, type 2 Diabetes Mellitus (DM), Cardiovascular Disease (CVD), and chronic kidney disease (CKD) as Cardiovascular-Kidney-Metabolic (CKM) syndrome, which confers increased risk of major adverse cardiac and cerebrovascular events (MACCE). We evaluated temporal trends in MACCE and mortality among geriatric patients with CKM. Methods: This was a retrospective cross-sectional trend analysis performed using the National Inpatient Sample (2016–2020). Geriatric admissions (≥65 years) with CKD (ICD-10 N18. x) and ≥1 cardiometabolic risk factor (hypertension, DM, hyperlipidaemia, or obesity) were identified. MACCE components included acute myocardial infarction (I21. x), ischemic stroke (I63. x), and cardiac arrest (I46. x). Patients were classified as MACCE-positive (MACCE+ve) or MACCEnegative (MACCE−ve). Trends, demographics, comorbidities, length of stay, costs, and all-cause mortality were compared. Results: Median age was 78 (72–85) years in both MACCE+ve and MACCE−ve cohorts. The MACCE+ve group had a higher proportion of males (55. 9% vs. 51. 1%). From 2016–2020, MACCE incidence increased from 10. 4% to 12. 7%, and mortality rose from 4. 6% to 6% (p-trend <0. 001), with a pronounced spike in 2020 coinciding with the COVID-19 pandemic. Compared with MACCE−ve patients, MACCE+ve patients had higher in-hospital mortality (15. 3% vs. 3. 4%), shorter length of stay (4 vs. 5 days), and greater hospitalization costs (66, 824 vs. 43, 727; p<0. 001). Discussion: MACCE and mortality increased progressively in elderly CKM patients, with disproportionate burden among males, racial/ethnic minorities, and lower-income populations. It underscores the need for improved risk stratification, equitable access to healthcare, and multidisciplinary, population-specific management strategies to mitigate cardiovascular risk and mortality. Conclusion: Our analysis suggests rising trends in MACCE in CKM syndrome, which significantly impact in-hospital outcomes. Considering limited data, longitudinal studies, riskprediction models, and population-level strategies are needed to improve prevention and management in this growing geriatric population.
Prajapati et al. (Tue,) studied this question.
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