Serum potassium and clinical outcomes in heart failure patients: results of risk calculations in 21 334 patients in the UK

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Serum potassium and clinical outcomes in heart failure patients : results of risk calculations in 21 334 patients in the UK

Linde, Cecilia (author): Karolinska Institutet

Qin, Lei (author): AstraZeneca, Global Hlth Econ, Gaithersburg, MD USA

Bakhai, Ameet (author): Royal Free Hosp, Dept Cardiol, London, England

Furuland, Hans (author): Uppsala universitet,Njurmedicin

Evans, Marc (author): Llandough Hosp, Diabet Resource Ctr, Cardiff, S Glam, Wales

Ayoubkhani, Daniel (author): Hlth Econ & Outcomes Res Ltd, Rhymney House,Unit A Copse Walk, Cardiff, S Glam, Wales

Palaka, Eirini (author): AstraZeneca, Global Hlth Econ, Cambridge, England

Bennett, Hayley (author): Hlth Econ & Outcomes Res Ltd, Rhymney House,Unit A Copse Walk, Cardiff, S Glam, Wales

McEwan, Phil (author): Hlth Econ & Outcomes Res Ltd, Rhymney House,Unit A Copse Walk, Cardiff, S Glam, Wales; Swansea Univ, Sch Human & Hlth Sci, Swansea, W Glam, Wales

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2019-01-10
2019
English.
In: ESC Heart Failure. - : Wiley. - 2055-5822. ; 6:2, s. 280-290

Related links:: https://doi.org/10.1...; show more...; https://uu.diva-port... (primary) (Raw object); https://www.onlineli...; https://urn.kb.se/re...; https://doi.org/10.1...; http://kipublication...; show less...

Journal article (peer-reviewed)

Abstract Subject headings

Aims: At present, the clinical burden of hypokalaemia and hyperkalaemia among European heart failure patients, and relationships between serum potassium and adverse clinical outcomes in this population, is not well characterized. The aim of this study was to investigate associations between mortality, major adverse cardiac events, and renin–angiotensin–aldosterone system inhibitor (RAASi) discontinuation across serum potassium levels, in a UK cohort of incident heart failure patients.Methods and results: This was a retrospective observational cohort study of newly diagnosed heart failure patients listed in the Clinical Practice Research Datalink, with a first record of heart failure (index date) between 2006 and 2015. Hypokalaemia and hyperkalaemia episodes were defined as the number of serum potassium measurements exceeding each threshold (<3.5, ≥5.0, ≥5.5, and ≥6.0 mmol/L), without such a measurement in the preceding 7 days. Risk equations developed using Poisson generalized estimating equations were utilized to estimate adjusted incident rate ratios (IRRs) relating serum potassium and clinical outcomes (death, major adverse cardiac event, and RAASi discontinuation). Among 21,334 eligible heart failure patients, 1969 (9.2%), 7648 (35.9%), 2725 (12.8%), and 763 (3.6%) experienced episodes of serum potassium <3.5, ≥5.0, ≥5.5, and ≥6.0 mmol/L, respectively. The adjusted IRRs for mortality exhibited a U‐shaped association pattern with serum potassium. Relative to the reference category (4.5 to <5.0 mmol/L), adjusted IRRs for mortality were estimated as 1.98 (95% confidence interval: 1.69–2.33), 1.23 (1.12–1.36), 1.35 (1.14–1.60), and 3.02 (2.28–4.02), for patients with serum potassium <3.5, ≥5.0 to <5.5, ≥5.5 to <6.0, and ≥6.0 mmol/L, respectively. The adjusted IRRs for major adverse cardiac events demonstrated a non‐statistically significant relationship with serum potassium. Discontinuation of RAASi therapy exhibited a J‐shaped trend in association with serum potassium. Compared with the reference category (4.5 to <5.0 mmol/L), adjusted IRRs were estimated as 1.07 (0.89–1.28) in patients with serum potassium <3.5 mmol/L, increasing to 1.32 (1.14–1.53) and 2.19 (1.63–2.95) among those with serum potassium ≥5.5 to <6.0 and ≥6.0 mmol/L, respectively.Conclusions: In UK patients with new onset heart failure, both hypokalaemia and hyperkalaemia were associated with increased mortality risk, and hyperkalaemia was associated with increased likelihood of RAASi discontinuation. Our results demonstrate the potential importance of serum potassium monitoring for heart failure outcomes and management.

Subject headings

MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)

Keyword

Hyperkalaemia
Serum potassium
Heart failure
Mortality
Renin-angiotensin-aldosterone system inhibitor therapy
Major adverse cardiac event

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By the author/editor: Linde, Cecilia; Qin, Lei; Bakhai, Ameet; Furuland, Hans; Evans, Marc; Ayoubkhani, Dani ...; show more...; Palaka, Eirini; Bennett, Hayley; McEwan, Phil; show less...

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MEDICAL AND HEALTH SCIENCES: MEDICAL AND HEAL ...; and Clinical Medicin ...; and Cardiac and Card ...

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By the university: Uppsala University; Karolinska Institutet

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