Annals of Medicine Research and Public Health (ISSN: 2995-5955) | Volume 5, Issue 2 | Editorial Article | Open Access
Pierantonio Russo, MD*
Pierantonio Russo, MD1, Brent Wright, RN, Dr PH2
1EVERSANA Data & Analytics, Overland Park, Kansas, USA
2iRhythm Technologies, San Francisco, California, USA
*Correspondence to: Pierantonio Russo, MD
Fulltext PDFThe American Heart Association’s cardiovascular-kidney-metabolic (CKM) framework, now codified in the 2026 AHA/ACC/ADA/ASN clinical practice guideline, describes a staged progression from excess adiposity to clinical cardiovascular disease. Within that architecture, atrial fibrillation appears only as a Stage 4 outcome. A growing body of national real-world evidence suggests this placement is incomplete. In cohorts of several million U.S. adults followed through administrative claims, major arrhythmias emerged at every CKM stage, rose steeply with stage progression, frequently preceded the diagnosis of chronic kidney disease, and, when they appeared after the onset of subclinical cardiovascular disease, marked a subgroup with substantially higher near-term risk of major adverse cardiovascular events. This editorial reviews that evidence in the context of the AHA/ACC guidance on CKM syndrome and argues that a documented major arrhythmia should be treated as a signpost of accelerating CKM progression and proposes four practical steps: stage-informed rhythm assessment, integration of arrhythmia status into CKM risk stratification, bidirectional kidney and rhythm surveillance, and prospective trials that test whether earlier detection changes outcomes. The observational nature of the supporting data and the limits of claims-based ascertainment are acknowledged; the case is for hypothesis-driven surveillance research, not for population screening.
Cardiovascular-kidney-metabolic syndrome; Atrial fibrillation, Chronic kidney disease, Obesity, Real-world evidence
Pierantonio Russo, Brent Wright. Arrhythmias and the Cardiovascular-Kidney-Metabolic Continuum. Ann Med Res Pub Health. 2026;5(2):1-7.