{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T00:59:13Z","timestamp":1784941153957,"version":"3.55.0"},"reference-count":40,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2025,5,6]],"date-time":"2025-05-06T00:00:00Z","timestamp":1746489600000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100008792","name":"Novartis Pharma Research Grants","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008792","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100013642","name":"Japan Heart Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100013642","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Research Grant"},{"DOI":"10.13039\/501100001691","name":"JSPS Kakenhi","doi-asserted-by":"publisher","award":["23K21594"],"award-info":[{"award-number":["23K21594"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001691","name":"JSPS Kakenhi","doi-asserted-by":"publisher","award":["19K11424"],"award-info":[{"award-number":["19K11424"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>The prevalence and impact of cardiovascular, kidney, and metabolic (CKM) overlap on physical function and prognosis in older patients with heart failure (HF) remain unclear. This study aimed to assess the impact of overlapping CKM conditions on physical function and prognosis in older patients with HF.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and results<\/jats:title>\n                  <jats:p>This post hoc analysis of the FRAGILE-HF (main cohort) and SONIC-HF (validation cohort), both prospective multi-centre studies, included patients aged \u226565 years who were hospitalized for HF. Cardiovascular, kidney, and metabolic overlap was defined as the presence of one or more of the following comorbidities: atherosclerotic cardiovascular disease, chronic kidney disease, or Type 2 diabetes mellitus. The primary outcome was a composite of all-cause death and HF readmission within 2 years. Physical function was assessed using gait speed, five-time chair stand test (5CST), short physical performance battery (SPPB), and 6 min walk test (6MWT). To validate the prognostic association of CKM overlap, we conducted an external validation using the SONIC-HF cohort, an independent prospective study with identical inclusion criteria. Of 1113 patients (mean age: 80 \u00b1 8 years, 58.1% male), 193 (17.3%) had no CKM conditions, 370 (33.2%) had one condition, and 550 (49.5%) had two or three conditions. A multivariable logistic regression model, adjusted for age, sex, comorbidities, and New York Heart Association functional class, showed that two or three CKM conditions were independently associated with lower physical function [5CST: odds ratio (OR) = 1.91, P &amp;lt; 0.001; SPPB: OR = 1.87, P = 0.001; 6MWT: OR = 1.84, P = 0.003]. Kaplan\u2013Meier analysis demonstrated a significant stepwise association between CKM overlap and the primary outcome in both the FRAGILE-HF and SONIC-HF cohorts (log-rank: P &amp;lt; 0.001). Adjusted Cox analysis demonstrated that the overlapping CKM conditions were associated with the primary outcome, with two or more CKM conditions showing a statistically significant association in the FRAGILE-HF cohort [hazard ratio (HR) = 1.64, P = 0.003]. Similarly, although statistical significance was not reached in the SONIC-HF cohort, a stepwise increase in HR was observed (two to three CKM conditions: HR = 1.90, 95% confidence interval: 0.97\u20133.73, P = 0.063).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Older patients with HF who have greater CKM overlap exhibited significantly poorer physical function and prognosis.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/eurjpc\/zwaf279","type":"journal-article","created":{"date-parts":[[2025,5,6]],"date-time":"2025-05-06T10:43:54Z","timestamp":1746528234000},"source":"Crossref","is-referenced-by-count":7,"title":["Association of cardiovascular-kidney-metabolic overlap with physical function and prognosis in older patients with heart failure: a <i>post hoc<\/i> analysis of the FRAGILE-HF and SONIC-HF"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9491-3286","authenticated-orcid":false,"given":"Taisuke","family":"Nakade","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine , 3-1-3 Hongo, Bunkyo-ku, Tokyo 113-8421 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2456-8525","authenticated-orcid":false,"given":"Yuya","family":"Matsue","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine , 3-1-3 Hongo, Bunkyo-ku, Tokyo 113-8421 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshiaki","family":"Ikeda","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine , 3-1-3 Hongo, Bunkyo-ku, Tokyo 113-8421 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daichi","family":"Maeda","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine , 3-1-3 Hongo, Bunkyo-ku, Tokyo 113-8421 ,","place":["Japan"]},{"name":"Department of Cardiology, Hirakata City Hospital , 2-14-1 Kinyahonmachi, Hirakata-shi, Osaka 573-1197 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nobuyuki","family":"Kagiyama","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine , 3-1-3 Hongo, Bunkyo-ku, Tokyo 113-8421 ,","place":["Japan"]},{"name":"Department of Cardiology, The Sakakibara Heart Institute of Okayama , 2-5-1 Nakaimachi, Kita-ku, Okayama City, Okayama 700-0804 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yudai","family":"Fujimoto","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine , 3-1-3 Hongo, Bunkyo-ku, Tokyo 113-8421 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanako","family":"Inoue","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine , 3-1-3 Hongo, Bunkyo-ku, Tokyo 113-8421 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tsutomu","family":"Sunayama","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine , 3-1-3 Hongo, Bunkyo-ku, Tokyo 113-8421 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taishi","family":"Dotare","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine , 3-1-3 Hongo, Bunkyo-ku, Tokyo 113-8421 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2011-8204","authenticated-orcid":false,"given":"Kentaro","family":"Jujo","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Nishiarai Heart Centre Hospital , 1-12-8 Nishiaraihommachi, Adachi-ku, Tokyo 123-0845 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuya","family":"Saito","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation, The Sakakibara Heart Institute of Okayama , 2-5-1 Nakaimachi, Kita-ku, Okayama City, Okayama 700-0804 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Kishibenishincho, Suita City, Osaka 564-8565 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kentaro","family":"Iwata","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation, Kobe City Medical Centre General Hospital , 1-1 Minatojimanaka-machi 2-chome, Chuo-ku, Kobe City, Hyogo 650-0047 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroshi","family":"Wada","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Saitama Medical Centre, Jichi Medical University , 847 Amanuma-cho 1-chome, Omiya-ku, Saitama City, Saitama 330-8503 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5747-7668","authenticated-orcid":false,"given":"Takatoshi","family":"Kasai","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine 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