External Validation of Proposed American Heart Association Algorithm for Cardiovascular Screening Before Kidney Transplantation

• Published in: Journal of the American Heart Association Vol. 12; no. 24; p. e031150
• Main Authors: Nielsen, Marie Bodilsen, Dahl, Jonathan Nørtoft, Jespersen, Bente, Ivarsen, Per, Birn, Henrik, Winther, Simon
• Format: Journal Article
• Language: English
• Published: England John Wiley and Sons Inc 19.12.2023; Wiley
• Subjects: Algorithms; American Heart Association; cardiovascular disease; Cardiovascular Diseases - prevention & control; Coronary Disease - diagnosis; coronary heart disease; Humans; kidney transplantation; Kidney Transplantation - adverse effects; Original Research; revascularization; Risk Factors; screening; United States - epidemiology; United States; cardiovascular disease; revascularization; screening; coronary heart disease; kidney transplantation
• ISSN: 2047-9980; 2047-9980
• DOI: 10.1161/JAHA.123.031150

Screening for cardiovascular disease is currently recommended before kidney transplantation. The present study aimed to validate the proposed algorithm by the American Heart Association (AHA-2022) considering cardiovascular findings and outcomes in kidney transplant candidates, and to compare AHA-2022 with the previous recommendation (AHA-2012). We applied the 2 screening algorithms to an observational cohort of kidney transplant candidates (n=529) who were already extensively screened for coronary heart disease by referral to cardiac computed tomography between 2014 and 2019. The cohort was divided into 3 groups as per the AHA-2022 algorithm, or into 2 groups as per AHA-2012. Outcomes were degree of coronary heart disease, revascularization rate following screening, major adverse cardiovascular events, and all-cause death. Using the AHA-2022 algorithm, 69 (13%) patients were recommended for cardiology referral, 315 (60%) for cardiac screening, and 145 (27%) no further screening. More patients were recommended cardiology referral or screening compared with the AHA-2012 (73% versus 53%; <0.0001). Patients recommended cardiology referral or cardiac screening had a higher risk of major adverse cardiovascular events (hazard ratio [HR], 5.5 [95% CI, 2.8-10.8]; and HR, 2.1 [95% CI, 1.2-3.9]) and all-cause death (HR, 12.0 [95% [CI, 4.6-31.4]; and HR, 5.3 [95% CI, 2.1-13.3]) compared with patients recommended no further screening, and were more often revascularized following initial screening (20% versus 7% versus 0.7%; <0.001). The AHA-2022 algorithm allocates more patients for cardiac referral and screening compared with AHA-2012. Furthermore, the AHA-2022 algorithm effectively discriminates between kidney transplant candidates at high, intermediate, and low risk with respect to major adverse cardiovascular events and all-cause death.