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Smith Lead Author in Study Showing Poor Survival in Patients with Heart Failure and Kidney Disease

Over 50 percent of patients with heart failure also have kidney disease and this combination results in poor survival, Yale School of Medicine researchers report in the Journal of the American College of Cardiology.

The researchers studied 80,098 heart failure patients, combining data from 16 prior studies and comparing survival in those patients with and without kidney disease.

“A growing number of patients in the United States have both heart failure and kidney disease. Both of these conditions are costly and burdensome,” said lead author Grace Smith, M.D., a student in the Division of Chronic Disease Epidemiology (CDE) at the Yale School of Public Health (YSPH). “While our study confirmed that heart failure patients with kidney disease had worse survival, we were surprised to discover that an extraordinary number of heart failure patients had kidney disease. Over half of the patients had at least mild disease and almost one third had moderate to severe disease.”

When followed for at least one year, 38 percent of patients with mild disease had died, as had as many as 51 percent with moderate to severe disease. “These mortality risks are comparable to risks attributed to deadly cancers,” said Smith.

“Of even more concern is the lack of treatment options for patients with heart failure and kidney disease,” said senior author Harlan Krumholz, M.D., professor of internal medicine, section of cardiology. “These patients have traditionally been excluded from clinical trials, most likely due to the severity of their illnesses.”

“Our results emphasize that we need to understand outcomes in these patients in order to improve treatment strategies,” said Krumholz. “This data may provide momentum for future research on interventions to change survival in this sick but substantial subgroup of heart failure patients.”

Co-authors on the study include Judith H. Lichtman, Ph.D., M.P.H., assistant professor in CDE at YSPH, Michael B. Bracken, Ph.D., M.P.H., Susan Dwight Bliss Professor of Epidemiology in CDE at YSPH, Michael Shlipak, Christopher Phillips and Paul DiCapua.

Citation: Journal of the American College of Cardiology 47: 1987-1996, 2006.