There are strong links between renal and cardiovascular disease, with chronic kidney disease contributing to around 12,000 excess heart attacks each year in England alone. However, siloed models of care may fail to deliver adequate care due to potential complex interactions between multiple disease management and the lack of continuity of care. In this piece, published as part of the Healthy Hearts collection on cardiovascular health, Dr Saif Al-Chalabi, Professor Smeeta Sinha, and Professor Philip Kalra outline a new, patient-centred model of healthcare to improve outcomes across cardiorenal disease, adopted across the Northern Care Alliance NHS Foundation Trust.

• The speciality-specific model of care in the UK creates a fragmented approach to treatment for people with multimorbidity, leading to recurrent hospital visits and admissions.
• Optimising care for people with cardiorenal metabolic diseases requires a patient-centred care led by interdisciplinary healthcare teams and supported by shared care protocols, telemedicine, and new funding models.
• Establishing a holistic healthcare approach would build on previous shifts towards integrated care, as well as current health policy strategies to move to a more digital, community-focused care model.

Cardiorenal metabolic diseases—including heart failure, chronic kidney disease (CKD), diabetes, and obesity—share overlapping pathophysiological pathways and risk factors. These conditions impose significant burdens on healthcare systems, and negatively impact clinical outcomes. Worldwide, CKD alone is responsible for approximately 1.4 million annual cardiovascular deaths, and over 25 million disability-adjusted life years (DALYs, equivalent to the loss of one year of healthy life).

In England, CKD is estimated to affect more than 7 million patients, of whom nearly half are living with later stage CKD (stages 3 – 5, marked by progressive loss of kidney function). This costs the NHS around £6.4 billion pounds in direct costs, while CKD also contributes to poor cardiovascular outcomes. Between 2009 – 2010, CKD contributed to more than 7,000 excess strokes and 12,000 excess myocardial infarctions (heart attacks), and for every 100 patients with later stage CKD, 6 will experience cardiovascular health events.

As with many conditions, health inequalities play a role. Research led by The University of Manchester showed an association between CKD and deprivation, with unemployment, lower educational attainment, and lower household income all associated with poorer health outcomes.

Given the links between renal and cardiovascular disease, it is clear that a holistic, patient-centred approach is needed to care. However, traditional, siloed specialty-specific models of care often fail to address the complexities of these interrelated conditions. This fragmented approach leads to inconvenience for patients, who face a greater number of healthcare appointments and interactions, and limits continuity of care. The result is complicated management, variable and inconsistent treatment, and diminished patient engagement.

The need for a patient-centred approach

Optimising health for individuals with cardiorenal metabolic diseases requires a patient-centred approach led by an interdisciplinary care team with appropriate competencies. This approach should leverage shared care protocols, integrated care across primary and secondary care as well as harnessing innovation. This may include utilising technology to support remote monitoring and delivery of care closer to home. To support these efforts, stakeholders and policymakers must adopt innovative policy models by allocating targeted funding and implementing frameworks that promote investment in prevention of long-term conditions, integrated and comprehensive care as well as  ensuring healthcare providers are well-equipped to deliver care for people living with multiple long-term conditions.

Moving away from traditional frameworks to adopt a strategic organisational approach that focuses on patients rather than a single disease or organ is essential. This shift allows funding to flow from individual services towards services with shared goals. Funding can be used to develop interdisciplinary teams, digitally enabled healthcare services, and patient self-management programmes. One way to divert more funding to these care models is to fundamentally change the predetermined set of outcomes, from disease-specific to patient-centred outcomes. This can be achieved by creating incentive structures for healthcare providers that reward the delivery of high-quality, coordinated care, including performance-based reimbursements that consider patient outcomes, satisfaction, and improvement in healthcare utilisation such as reductions in hospital readmissions. Reform of funding mechanisms to enable multi-year spending offer prevention focused offer may also enable systems to invest in prevention endeavours.

Reforms are needed to equip healthcare professionals with the necessary skills to care for patients with this cluster of interrelated conditions. General medical training includes cardiology, nephrology and endocrinology; however, services are largely confined to single specialties. The re-design of service models will enable medical teams to review patients across cardiovascular, renal, and metabolic conditions, rather than within the confines of an individual specialty.

This redesign applies to other healthcare professionals, who may benefit from the development of cardiorenal metabolic (CKM) competencies through modular training pathways. For instance, heart failure nurses may be able to develop competencies in CKD and diabetes recognition and optimisation.

Digital and physical infrastructure needs

Enhancing clinical services for cardiorenal metabolic diseases requires significant improvements in digital and physical infrastructure. Examples include systems that link electronic patient records between primary and secondary care, electronic alert systems to identify early changes in important cardiovascular parameters, and wearable technology for remote monitoring of cardiovascular parameters such as blood pressure. The main barrier to developing these services is cost, which can be addressed by evaluating the value of these services in preventing cardiovascular and renal events, thereby reducing medical care costs and sickness-related work absences.

Benefits of comprehensive services

Establishing comprehensive services for cardiorenal metabolic diseases can improve the uptake of cardio-renal protective therapies, optimise metabolic management, enhance clinical outcomes and quality of life, and allow rapid translation of advances in cardiorenal metabolic diseases into clinical practice. A cardiorenal metabolic service localises care through primary-secondary care coordination, enabling personalised and less fragmented treatment. It empowers patients with digital tools to manage their health and prevents prolonged illness by addressing cardiorenal metabolic risks early, reducing complications like cardiovascular events.

Aligning with government health strategies

This approach aligns with current health policy’s three strategic shifts in care delivery: hospital to the community, analogue to digital, and sickness to prevention.

The priority of moving from analogue to digital includes elements such as shared electronic patient health records, digital infrastructure, and data safeguarding. The University of Manchester is already leading work in this area, and an integrated cardiorenal care service would build on this learning. In particular, a shift to telehealth has the potential to address the disparity in health outcomes identified in more deprived areas, by improving access to healthcare service via remote technologies.

Community care, including the expansion of Community Diagnostic Centres and the shift to a ‘Neighbourhood Health Service’ approach for the NHS, play crucial roles in moving cardiorenal care to a more community-based, preventative focus. Identifying high-risk individuals in the community allows for early intervention to correct their disease trajectory, reducing morbidity and disability. For example, early identification of identification of increased levels of albuminuria (an early sign of kidney disease) in a patient with diabetes and starting appropriate medications can significantly halt CKD progression and reduce cardiovascular events.

Conclusion

Transforming care for cardiorenal metabolic diseases from siloed to comprehensive, patient-centred approaches is essential for improving clinical outcomes and reducing healthcare burdens. By adopting strategic funding, educational reforms, and enhancing digital and physical infrastructure, we can create a more integrated and effective healthcare system that benefits patients, healthcare providers, and the NHS as a whole.