Frequency and clinical impact of hyperkalaemia within a large, modern, real‐world heart failure population
Abstract Aims This analysis qualitatively describes the impact of hyperkalaemia (HK) and renin‐angiotensin‐aldosterone system inhibitor (RAASi) use on clinical outcomes in patients with heart failure (HF). Methods and results Patients were included if they were ≥18 years old; had a serum potassium r...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2021-02-01
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| Series: | ESC Heart Failure |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/ehf2.13164 |
| _version_ | 1818725355984257024 |
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| author | Joseph B. Muhlestein Jennifer Kammerer Tami L. Bair Kirk U. Knowlton Viet T. Le Jeffrey L. Anderson Donald L. Lappé Heidi T. May |
| author_facet | Joseph B. Muhlestein Jennifer Kammerer Tami L. Bair Kirk U. Knowlton Viet T. Le Jeffrey L. Anderson Donald L. Lappé Heidi T. May |
| author_sort | Joseph B. Muhlestein |
| collection | DOAJ |
| description | Abstract Aims This analysis qualitatively describes the impact of hyperkalaemia (HK) and renin‐angiotensin‐aldosterone system inhibitor (RAASi) use on clinical outcomes in patients with heart failure (HF). Methods and results Patients were included if they were ≥18 years old; had a serum potassium result between 1 January 2003 and 3 December 2018; had ≥2 separate, non‐urgent care or emergency department encounters; and had an HF diagnosis. Criteria were met by 52 253 patients; 48 333 had sufficient follow‐up for analysis. Patients were stratified by the presence/absence of HK (serum potassium >5.0 mmol/L) (n = 31 619 and n = 20 634, respectively) and by baseline left ventricular ejection fraction (LVEF) ≤40% or >40%. Compared with patients without HK (no‐HK), those with HK had significantly higher rates of baseline cardiovascular risk factors, prior diagnoses, and greater RAASi use in both baseline and follow‐up periods. Assessed outcomes included RAASi use, rate of 3 year major adverse cardiovascular events (MACE), and individual component rates. Between baseline and follow‐up analyses, the proportion of patients on RAASi decreased by 5% in patients with HK but increased by 20% in no‐HK patients. Overall, MACE and death were consistently highest in the presence of HK without RAASi treatment (63% and 62%, respectively) and lowest in no‐HK but on RAASi (25% and 21%, respectively). After complete multivariable adjustment, these trends were consistent regardless of baseline LVEF. Conclusions In this large, real‐world HF population, HK was common and linked to baseline clinical risk factors, declining use of RAASi treatment, and an increase in future MACE, regardless of baseline LVEF. Both HK and reduced RAASi use were independent predictors of future MACE. |
| first_indexed | 2024-12-17T21:41:00Z |
| format | Article |
| id | doaj.art-c9f79f98cd8944d0b1f4056d1da5f8f0 |
| institution | Directory Open Access Journal |
| issn | 2055-5822 |
| language | English |
| last_indexed | 2024-12-17T21:41:00Z |
| publishDate | 2021-02-01 |
| publisher | Wiley |
| record_format | Article |
| series | ESC Heart Failure |
| spelling | doaj.art-c9f79f98cd8944d0b1f4056d1da5f8f02022-12-21T21:31:38ZengWileyESC Heart Failure2055-58222021-02-018169169610.1002/ehf2.13164Frequency and clinical impact of hyperkalaemia within a large, modern, real‐world heart failure populationJoseph B. Muhlestein0Jennifer Kammerer1Tami L. Bair2Kirk U. Knowlton3Viet T. Le4Jeffrey L. Anderson5Donald L. Lappé6Heidi T. May7Department of Cardiology Intermountain Medical Center Heart Institute 5121 S. Cottonwood Street Salt Lake City UT 84157 USAManaged Care Health Outcomes Relypsa, Inc., a Vifor Pharma Group Company Redwood City CA USABioinformatics Intermountain Medical Center Heart Institute Salt Lake City UT USADepartment of Cardiology Intermountain Medical Center Heart Institute 5121 S. Cottonwood Street Salt Lake City UT 84157 USADepartment of Cardiology Intermountain Medical Center Heart Institute 5121 S. Cottonwood Street Salt Lake City UT 84157 USADepartment of Cardiology Intermountain Medical Center Heart Institute 5121 S. Cottonwood Street Salt Lake City UT 84157 USADepartment of Cardiology Intermountain Medical Center Heart Institute 5121 S. Cottonwood Street Salt Lake City UT 84157 USAEpidemiology Intermountain Medical Center Heart Institute Salt Lake City UT USAAbstract Aims This analysis qualitatively describes the impact of hyperkalaemia (HK) and renin‐angiotensin‐aldosterone system inhibitor (RAASi) use on clinical outcomes in patients with heart failure (HF). Methods and results Patients were included if they were ≥18 years old; had a serum potassium result between 1 January 2003 and 3 December 2018; had ≥2 separate, non‐urgent care or emergency department encounters; and had an HF diagnosis. Criteria were met by 52 253 patients; 48 333 had sufficient follow‐up for analysis. Patients were stratified by the presence/absence of HK (serum potassium >5.0 mmol/L) (n = 31 619 and n = 20 634, respectively) and by baseline left ventricular ejection fraction (LVEF) ≤40% or >40%. Compared with patients without HK (no‐HK), those with HK had significantly higher rates of baseline cardiovascular risk factors, prior diagnoses, and greater RAASi use in both baseline and follow‐up periods. Assessed outcomes included RAASi use, rate of 3 year major adverse cardiovascular events (MACE), and individual component rates. Between baseline and follow‐up analyses, the proportion of patients on RAASi decreased by 5% in patients with HK but increased by 20% in no‐HK patients. Overall, MACE and death were consistently highest in the presence of HK without RAASi treatment (63% and 62%, respectively) and lowest in no‐HK but on RAASi (25% and 21%, respectively). After complete multivariable adjustment, these trends were consistent regardless of baseline LVEF. Conclusions In this large, real‐world HF population, HK was common and linked to baseline clinical risk factors, declining use of RAASi treatment, and an increase in future MACE, regardless of baseline LVEF. Both HK and reduced RAASi use were independent predictors of future MACE.https://doi.org/10.1002/ehf2.13164HyperkalaemiaLVEFMACERAAS inhibitorsHeart failure |
| spellingShingle | Joseph B. Muhlestein Jennifer Kammerer Tami L. Bair Kirk U. Knowlton Viet T. Le Jeffrey L. Anderson Donald L. Lappé Heidi T. May Frequency and clinical impact of hyperkalaemia within a large, modern, real‐world heart failure population ESC Heart Failure Hyperkalaemia LVEF MACE RAAS inhibitors Heart failure |
| title | Frequency and clinical impact of hyperkalaemia within a large, modern, real‐world heart failure population |
| title_full | Frequency and clinical impact of hyperkalaemia within a large, modern, real‐world heart failure population |
| title_fullStr | Frequency and clinical impact of hyperkalaemia within a large, modern, real‐world heart failure population |
| title_full_unstemmed | Frequency and clinical impact of hyperkalaemia within a large, modern, real‐world heart failure population |
| title_short | Frequency and clinical impact of hyperkalaemia within a large, modern, real‐world heart failure population |
| title_sort | frequency and clinical impact of hyperkalaemia within a large modern real world heart failure population |
| topic | Hyperkalaemia LVEF MACE RAAS inhibitors Heart failure |
| url | https://doi.org/10.1002/ehf2.13164 |
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