The American Heart Association’s recent presidential advisory¹ on cardiovascular-kidney-metabolic (CKM) health aims for greater consensus on the definition of CKM syndrome.

It provides guidance for staging, prediction strategies, and algorithms for prevention and treatment across diverse patient populations. We’ll cover several highlights from the advisory and explore how this guidance may provide growth opportunities for the world of point-of-care testing.

1. What is CKM syndrome and who does it impact the most?

As a health disorder that combines the physiological processes of obesity, diabetes, chronic kidney disease, and cardiovascular disease (CVD), CKM is characterized by heart failure, atrial fibrillation, coronary heart disease, stroke, and peripheral artery disease. It includes those individuals at risk for CVD and those already with CVD, which increases its prevalence within the population and burdens those facing adverse social determinants of health (SDOH).

2. What are the proposed CKM staging constructs?

The advisory’s proposed staging model acknowledges the progressive nature of CKM. It also emphasizes the need for earlier detection and intervention of disease-related changes.

3. What are the CKM screening recommendations?

The advisory divides screening into two major categories: screening for biological factors across the patient’s lifespan (with the focus on early identification and intervention), and screenings for SDOH. This approach underscores the need for screenings to be accessible, reproducible, highly accurate, and active within the population.

Screening Frequency Recommendations

• Children with no CKM risk factors should be screened annually, starting at age 3
• Children with CKM risk factors (overweight/obesity, diabetes, kidney disease, heart disease) should be screened at every health visit, beginning at age 3
• Lipid panel screening recommended for all children between 9 and 11 years of age, and again from 17 to 21 years
• If test is normal, repeat every 2-3 years for obese children (and for overweight children if a second risk factor is present)
• Adults ≥ 21 years of age with ≥ Stage 2 CKM, annually
• Adults ≥ 21 years of age with Stage 1 CKM or history of gestational diabetes, every 2-3 years
• Adults ≥ 21 years of age with Stage 0 CKM, every 3-5 years

4. What are the new approaches for assessing risk and predicting outcomes?

The advisory proposes a new CKM risk calculator and recommends assessing risk for atherosclerotic cardiovascular disease (ASCVD) and heart failure (HF), incorporating risk assessment beginning at age 30. This model quantifies the absolute risk of developing any CVD event along with ASCVD and HF. Once risk is quantified, it must be translated and implemented into clinical care to improve outcomes.

5. How important is screening for social determinants of health (SDOH)?

Individuals with adverse social determinants of health (SDOH) have a higher risk of CKM syndrome, primarily driven by the higher burden of metabolic risk factors within historically disenfranchised populations. SDOH can be conceptualized within a socioecological framework in which societal factors, community, and interpersonal relationships affect each other and strongly influence individual health behaviors. Individual biological predisposition, nested within these multiple levels of social influence, further affects CKM syndrome development and related outcomes.

The advisory recommends screening systematically for SDOH, incorporating these factors into risk prediction models. Addressing SDOH should also be an essential part of clinical care for CKM syndrome patients as they have a significant impact on management and outcomes.

6. What is the potential of point-of-care testing in CKM health?

CKM is a growing problem in the general population, and especially in areas of economic disadvantage, due to fewer healthcare providers, educational resources, and treatment facilities. However, the convenience of POCT devices like the Afinion™ 2 and Cholestech LDX™ analyzers from Abbott, are making it easier for underserved populations to access diagnostic testing for CKM and other potential health issues at community centers, clinics, and retail pharmacies. And, with patients having greater access to POCT, health care providers can provide them with immediate, coachable moments and treatment decisions, while eliminating the need for lab visits. In this way, POCT has the capability of improving patient compliance and outcomes.

Next steps for optimizing CKM health in the population:

Optimizing CKM health in the population will require a multifaceted, concerted and patient-centered effort involving multilevel partnerships among clinical entities, policymakers, payers, and numerous stakeholders, as well as the enhancement of education and research related to CKM syndrome.

The components of this call to action include:

1. Systematically considering social determinants of health (SDOH) in the care model for CKM syndrome;
2. Enhancing access to pharmacotherapies that positively affect outcomes related to CKM syndrome;
3. Addressing research gaps related to CKM syndrome;
4. Facilitating interdisciplinary care and reducing care fragmentation;
5. Improving education of health care professionals and the lay community related to CKM syndrome;
6. Enhancing management of obesity as the root cause of much of CKM syndrome;
7. Implementing CKM syndrome care models within and across health centers; and
8. Building multistakeholder partnerships to support healthy lifestyle and the achievement of ideal cardiovascular health across diverse communities.
   
   

For more information on Abbott’s point-of-care testing offerings to help you optimize the health of your CKM patients, please contact your Abbott Cardiometabolic Account Executive.