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Impact of eplerenon...
Impact of eplerenone on cardiovascular outcomes in heart failure patients with hypokalaemia
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Rossignol, Patrick (författare)
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Girerd, Nicolas (författare)
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Bakris, George (författare)
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visa fler...
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Vardeny, Orly (författare)
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Claggett, Brian (författare)
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McMurray, John J.V. (författare)
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- Swedberg, Karl, 1944 (författare)
- Gothenburg University,Göteborgs universitet,Institutionen för medicin, avdelningen för molekylär och klinisk medicin,Institute of Medicine, Department of Molecular and Clinical Medicine
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Krum, Henry (författare)
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van Veldhuisen, Dirk J. (författare)
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Shi, Harry (författare)
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Spanyers, Sean (författare)
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Vincent, John (författare)
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Fay, Renaud (författare)
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Lamiral, Zohra (författare)
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Solomon, Scott D. (författare)
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Zannad, Faiez (författare)
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Pitt, Bertram (författare)
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(creator_code:org_t)
- 2016-11-20
- 2017
- Engelska.
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Ingår i: European Journal of Heart Failure. - : Wiley. - 1388-9842 .- 1879-0844. ; 19:6, s. 792-799
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https://gup.ub.gu.se...
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Abstract
Ämnesord
Stäng
- © 2016 The Authors. European Journal of Heart Failure © 2016 European Society of Cardiology Aims: Although hypokalaemia is common among patients with heart failure (HF), the prognostic significance of baseline hypokalaemia and hypokalaemia during follow-up in HF patients receiving a mineralocorticoid receptor antagonist (MRA) remains uncertain. Methods and results: Results of the EMPHASIS-HF trial in patients (n = 2737) with HF and reduced EF with mild symptoms, randomized to eplerenone or placebo, were analysed with regard to the presence or occurrence of hypokalaemia (serum K + < 4.0 mmol/L) and the risk of cardiovascular death or hospitalization for HF (primary endpoint). Median follow-up was 21 months. Baseline hypokalaemia and hypokalaemia during follow-up were common occurrences (19.6% and 40.6%, respectively). Hypokalaemia during follow-up was associated with worse outcomes in multivariable analyses [hazard ratio (HR) 1.26, 95% confidence interval (CI) 1.05–1.52, P = 0.01] without evidence of interaction with eplerenone. In contrast, baseline hypokalaemia was associated with outcomes in the placebo group (HR 1.37, 95% CI 1.05–1.79, P = 0.02) but not in the eplerenone group (HR 0.87, 95% CI 0.62–1.23, P = 0.44; P for interaction = 0.04). Concurrently, eplerenone was found to be more protective in patients with baseline hypokalaemia vs. patients without baseline hypokalaemia compared with placebo (HR 0.44, 95% 0.30–0.64, P < 0.0001 vs. 0.69, 95% CI 0.57–0.83, P = 0.0001; P for interaction = 0.04). In patients without baseline hypokalaemia, eplerenone use decreased the rate of hypokalaemia during follow-up (HR 0.69, 95% CI 0.59–0.80, P < 0.001). A potassium level > 4.0 mmol/L at 1 month after randomization mediated 26.0% (0.6–51.4%) of the eplerenone treatment effect (P = 0.04). Conclusion: In HF patients receiving optimal therapy but not treated with eplerenone, baseline hypokalaemia was associated with worse outcomes. Conversely, hypokalaemia amplified the treatment effect of eplerenone.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine (hsv//eng)
Nyckelord
- Eplerenone
- Heart failure
- Potassium
- Prognosis
Publikations- och innehållstyp
- ref (ämneskategori)
- art (ämneskategori)
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Rossignol, Patri ...
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Girerd, Nicolas
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Bakris, George
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Vardeny, Orly
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Claggett, Brian
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McMurray, John J ...
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visa fler...
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Swedberg, Karl, ...
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Krum, Henry
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van Veldhuisen, ...
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Shi, Harry
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Spanyers, Sean
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Vincent, John
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Fay, Renaud
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Lamiral, Zohra
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Solomon, Scott D ...
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Zannad, Faiez
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Pitt, Bertram
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visa färre...
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- MEDICIN OCH HÄLSOVETENSKAP
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och Klinisk medicin
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European Journal ...
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Göteborgs universitet