A new survey of nearly 100 U.S. primary care and other outpatient facilities reveals that while basic screening for heart, kidney and metabolic risks is common, far fewer clinics are adopting newer, guideline-recommended tools for assessing cardiovascular-kidney-metabolic (CKM) syndrome. The findings, presented as preliminary research at the American Heart Association’s Scientific Sessions 2026, underscore a critical gap in translating evolving evidence into routine clinical practice.
The American Heart Association defines cardiovascular-kidney-metabolic (CKM) syndrome as a multi-system health disorder driven by connections between obesity, Type 2 diabetes, chronic kidney disease and heart disease. Nearly 90% of U.S. adults have at least one component of CKM syndrome, such as high blood pressure, abnormal cholesterol, high blood glucose, excess weight or reduced kidney function. This high prevalence makes effective screening and risk assessment essential for preventing progression to more severe disease.
The survey was a baseline assessment of clinical sites participating in the American Heart Association’s learning collaborative and quality improvement initiative, launched in 2025 to promote a CKM-coordinated care model across about 150 sites. Of the 97 sites that completed the questionnaire, 75% reported screening for CKM-related conditions and 73% systematically tested patient populations for CKM risk factors. However, only 28% used the PREVENT equations to estimate cardiovascular risk, and only 22% used CKM syndrome staging. Additionally, just 22% of sites reported measuring waist circumference as standard practice.
“We found that most of the sites were actively screening patients for CKM risk factors and related conditions. Far fewer were using specifically recommended clinical assessment tools such as CKM syndrome staging and the PREVENT equations,” said lead author Chiadi Ndumele, M.D., Ph.D., M.H.S., FAHA, director of the Penn Center for Cardiometabolic Health at the University of Pennsylvania. “These tools – and even CKM syndrome as a medical condition – embrace relatively new concepts just beginning to be adopted. This baseline is important because it shows we have opportunity to improve patient care.”
The implications are significant. CKM syndrome staging categorizes patients into four stages reflecting disease evolution, from excess fat accumulation to clinical heart disease. The PREVENT equations, based on data from more than 6.5 million diverse U.S. adults, estimate 10-year and 30-year cardiovascular risk for people ages 30-79 without known heart disease. Together, these tools can identify specific risks and guide more personalized preventive care. Their low adoption suggests that many clinics may miss opportunities to intervene early, particularly among populations disproportionately affected by conditions such as obesity, diabetes, chronic kidney disease and heart disease.
The survey also highlights that the initiative sites, selected based on CKM burden and structural factors, represent a range of organization types: 44% safety net, 39% non-academic and 16% academic. As a baseline, the data provide a blueprint for implementation efforts and could inform other health systems seeking to improve CKM care. The findings are considered preliminary until published in a peer-reviewed journal, and ongoing assessments will further explore barriers and opportunities. For more details, the abstract and Online Program Planner are available, along with the Association’s First-ever guideline on cardiovascular-kidney-metabolic syndrome issued.
