The following is a summary of “External Validation of Proposed American Heart Association Algorithm for Cardiovascular Screening Before Kidney Transplantation,” published in the December 2023 issue of Cardiology by Nielsen et al.

The current practice advises cardiovascular disease screening before kidney transplantation. This study aimed to verify the American Heart Association’s (AHA-2022) proposed algorithm by assessing cardiovascular outcomes in kidney transplant candidates and comparing it with the prior recommendation (AHA-2012). Using both algorithms, the researchers evaluated an observational cohort of kidney transplant candidates (n=529) who had undergone comprehensive coronary heart disease screening through cardiac computed tomography between 2014 and 2019. The cohort was categorized into three groups based on the AHA-2022 algorithm or two groups according to AHA-2012. 

The study group assessed outcomes, including the severity of coronary heart disease, revascularization rates post-screening, major adverse cardiovascular events, and all-cause mortality. The AHA-2022 algorithm suggested cardiology referral for 13% of patients, cardiac screening for 60%, and no further screening for 27%. Comparatively, more patients were recommended cardiology referral or screening under AHA-2022 than AHA-2012 (73% versus 53%; P<0.0001). Patients directed for cardiology referral or cardiac screening showed higher risks 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 mortality (HR, 12.0 [95% CI, 4.6–31.4]; and HR, 5.3 [95% CI, 2.1–13.3]) compared to those recommended no further screening. Moreover, individuals directed for cardiology referral or screening were more frequently revascularized post-initial screening (20% versus 7% versus 0.7%; P<0.001). 

In conclusion, the AHA-2022 algorithm assigns more patients for cardiac referral and screening than the AHA-2012. Notably, AHA-2022 effectively discriminates between kidney transplant candidates at high, intermediate, and low risk concerning major adverse cardiovascular events and all-cause mortality.

Source: ahajournals.org/doi/10.1161/JAHA.123.031150