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, adoption of newer, guideline-recommended assessment tools for cardiovascular-kidney-metabolic (CKM) syndrome remains low. The findings, presented as preliminary research at the American Heart Association’s Scientific Sessions 2026, underscore a critical gap in translating evolving clinical guidelines into routine practice—a gap that could affect millions of Americans at risk for interconnected chronic conditions.
The American Heart Association defines cardiovascular-kidney-metabolic (CKM) syndrome as a multi-system health disorder arising from 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, reduced kidney function or related heart conditions. Because these conditions cluster together, the Association launched a learning collaborative and quality improvement initiative in 2025 to promote a CKM-coordinated care model across about 150 clinical sites.
The survey, a baseline assessment of sites participating in the initiative, found that 75% screened for CKM-related conditions, 73% systematically tested patient populations for CKM risk factors, and 75% conducted social drivers of health screenings. However, only 28% used the PREVENT™ equations to estimate cardiovascular disease risk, and just 22% used CKM syndrome staging. Only 22% of sites reported measuring patients’ waist circumference as standard practice. The survey included 97 clinical sites that completed a standardized questionnaire between August 2025 and June 2026; 92% identified as outpatient facilities, with 44% safety net, 39% non-academic and 16% academic.
“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 and Presidential Professor of Medicine at the University of Pennsylvania. “However, that isn’t entirely surprising. 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 as we help clinicians understand how to better incorporate these tools into their practices.”
The implications are significant. CKM syndrome staging categorizes patients into four stages, from excess or dysfunctional fat to clinical heart disease, and allows clinicians to identify specific risks and tailor preventive care. 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, improving accuracy over previous tools. Wider adoption could lead to earlier detection, more coordinated care and better outcomes for patients with interconnected chronic conditions. The findings may also inform other health systems seeking to improve CKM care, as detailed in the release link and the abstract.
Study limitations include that data from only 97 of 150 sites were available, self-reported data may be subject to recall bias, and sites were selected by the initiative, introducing potential selection bias. Ongoing assessments will provide a more comprehensive understanding of implementation barriers and opportunities. The preliminary findings highlight a need for targeted efforts to integrate comprehensive CKM assessment into routine practice, a step that could reshape care for millions of Americans. The research is scheduled for presentation at Scientific Sessions 2026 in Chicago, Nov. 6–9.
