Associazione Nazionale Medici Cardiologi Ospedalieri

congress.anmco.it

CONGRESS ABSTRACT

CONGRESS ABSTRACT

IMPLEMENTING THE CARDIO-KIDNEY-METABOLIC (CKM) FRAMEWORK TO BRIDGE THE THERAPEUTIC GAP IN HEART FAILURE: RESULTS FROM A REAL-WORLD QUALITY IMPROVEMENT PROJECT

Halasz Geza Roma (Roma ) – Azienda Ospedaliera San Camillo Forlanini | Mistrulli Raffaella Roma (Roma) – Azienda Ospedaliera Universitaria Sant’Andrea | Terranova Antonio Roma (Roma) – Azienda Ospedaliera San Camillo Forlanini | Pugliese Marco Roma (Roma) – Azienda Ospedaliera San Camillo Forlanini | Matera Sabrina Roma (Roma) – Azienda Ospedaliera San Camillo Forlanini | Pandolfi Claudia Roma (Roma) – Azienda Ospedaliera San Camillo Forlanini | Re Federica Roma (Roma) – Azienda Ospedaliera San Camillo Forlanini | Giacalone Guido Roma (Roma) – Azienda Ospedaliera Universitaria Sant’Andrea | Gabrielli Domenico Roma (Roma) – Azienda Ospedaliera San Camillo Forlanini

Background: The Cardio-Kidney-Metabolic (CKM) syndrome represents a clinical continuum where metabolic disorders, chronic kidney disease (CKD), and heart failure (HF) mutually exacerbate cardiovascular risk. Despite international guidelines recommending SGLT2 inhibitors (SGLT2i) as a cornerstone of treatment across the entire ejection fraction spectrum, a significant therapeutic gap persists in clinical practice. This study evaluates the impact of a targeted clinical intervention ("Gruppi di Miglioramento") on therapeutic optimization in a high-risk cohort. Methods: We analyzed a cohort of 151 patients (predominantly male, mean age 66 years) characterized by an HFpEF phenotype and comorbid CKD. A specific subgroup of 54 patients with documented therapeutic gaps was followed to assess the impact of a structured clinical audit and optimized pharmacological management on the prescription rates of disease-modifying therapies, with a focus on SGLT2i (Empagliflozin). Results: Baseline analysis revealed a significant under-treatment in the HFpEF and CKD subgroups. Following the intervention, a dramatic increase in guideline-directed medical therapy (GDMT) was observed. Specifically, SGLT2i coverage increased from 14.7% to 85.3% in HFpEF patients (+70.6% ) and from 17.9% to 78.6% in CKD patients (+60.7% ). Significant improvements were also noted in patients with Type 2 Diabetes (from 15.4% to 69.2%). Overall, the project achieved a target therapeutic coverage >85% for cardio-renal protection. Notably, patients with HFpEF reached the same intensity of care as those with HFrEF, ensuring therapeutic equity. Conclusions: The implementation of a structured "Quality Improvement" strategy effectively bridged the therapeutic gap in a complex CKM population. Targeted clinical interventions can rapidly optimize GDMT, ensuring that high-risk patients, particularly those with HFpEF and CKD, receive evidence-based treatments that simultaneously address cardiac, renal, and metabolic risks, thereby improving long-term prognostic outcomes.