Serum potassium level and mineralocorticoid receptor antagonist dose in a large cohort of chronic heart failure patients
Abstract Aims Hyperkalaemia is observed frequently in heart failure (HF) patients and is associated with an impaired prognosis and underuse of mineralocorticoid receptor antagonists (MRAs). However, the effects of serum potassium on prescription of the full guideline recommended daily dose of 50 mg...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2023-04-01
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| Series: | ESC Heart Failure |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/ehf2.14285 |
| _version_ | 1797857588121960448 |
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| author | Pascal R. D. Clephas Sumant P. Radhoe Gerard C. M. Linssen Jorina Langerveld Jacobus Plomp Jeroen P. P. Smits Michiel J. Nagelsmit Hans‐Peter Brunner‐La Rocca Jasper J. Brugts |
| author_facet | Pascal R. D. Clephas Sumant P. Radhoe Gerard C. M. Linssen Jorina Langerveld Jacobus Plomp Jeroen P. P. Smits Michiel J. Nagelsmit Hans‐Peter Brunner‐La Rocca Jasper J. Brugts |
| author_sort | Pascal R. D. Clephas |
| collection | DOAJ |
| description | Abstract Aims Hyperkalaemia is observed frequently in heart failure (HF) patients and is associated with an impaired prognosis and underuse of mineralocorticoid receptor antagonists (MRAs). However, the effects of serum potassium on prescription of the full guideline recommended daily dose of 50 mg in real‐world daily practice are unknown. Therefore, we investigated serum potassium and its association with the prescribed MRA dose in a large cohort of chronic HF patients. Methods and results A total of 5346 patients with chronic HF with a left ventricular ejection fraction ≤40% from 34 Dutch outpatient HF clinics between 2013 and 2016 were analysed on serum potassium and MRA (spironolactone and eplenerone) dose. Data were stratified by potassium as a serum potassium level <4.0, 4.0 to 5.0 or >5.0 mmol/L. Multivariable logistic regression models were used to assess the association between serum potassium and MRA dose and to adjust for potential confounders. Mean serum potassium was 4.4 ± 0.5 mmol/L and hyperkalaemia (serum potassium >5.0 mmol/L) was present in 399 patients (7.5%). MRA was used in 3091 patients (58.1%). Patients with hyperkalaemia significantly less often received ≥100% of the target dose (50 mg) compared with patients with a serum potassium between 4.0–5.0 mmol/L and <4.0 mmol/L (7.7% vs. 9.5% vs. 13.6% respectively, P = 0.0078). In the multivariable regression analyses, patients with hyperkalaemia were significantly less likely to receive ≥100% of the target dose compared with patients with serum potassium 4.0–5.0 mmol/L (OR 0.38, 95% CI 0.15–0.97, P = 0.044). Additionally, a one unit increase in serum potassium was significantly associated with a lower odds of receiving ≥100% of the target dose (OR 0.69, 95% CI 0.49–0.98, P = 0.036). Conclusions In this large registry of real‐world chronic HF patients, both an increase in serum potassium and hyperkalaemia were associated with a lower odds of receiving the guideline‐recommended MRA dose. |
| first_indexed | 2024-04-09T21:00:16Z |
| format | Article |
| id | doaj.art-f0f352bda9774d41ba51bcdc28fb7a28 |
| institution | Directory Open Access Journal |
| issn | 2055-5822 |
| language | English |
| last_indexed | 2024-04-09T21:00:16Z |
| publishDate | 2023-04-01 |
| publisher | Wiley |
| record_format | Article |
| series | ESC Heart Failure |
| spelling | doaj.art-f0f352bda9774d41ba51bcdc28fb7a282023-03-29T11:45:21ZengWileyESC Heart Failure2055-58222023-04-011021481148710.1002/ehf2.14285Serum potassium level and mineralocorticoid receptor antagonist dose in a large cohort of chronic heart failure patientsPascal R. D. Clephas0Sumant P. Radhoe1Gerard C. M. Linssen2Jorina Langerveld3Jacobus Plomp4Jeroen P. P. Smits5Michiel J. Nagelsmit6Hans‐Peter Brunner‐La Rocca7Jasper J. Brugts8Department of Cardiology Erasmus MC, University Medical Center Rotterdam Rotterdam The NetherlandsDepartment of Cardiology Erasmus MC, University Medical Center Rotterdam Rotterdam The NetherlandsDepartment of Cardiology Hospital Group Twente Hengelo The NetherlandsDepartment of Cardiology Hospital Rivierenland Tiel The NetherlandsDepartment of Cardiology Tergooi Blaricum The NetherlandsDepartment of Cardiology Zuwe Hofpoort Hospital Woerden The NetherlandsDepartment of Cardiology Scheper Hospital Emmen The NetherlandsDepartment of Cardiology Maastricht University Medical Center Maastricht The NetherlandsDepartment of Cardiology Erasmus MC, University Medical Center Rotterdam Rotterdam The NetherlandsAbstract Aims Hyperkalaemia is observed frequently in heart failure (HF) patients and is associated with an impaired prognosis and underuse of mineralocorticoid receptor antagonists (MRAs). However, the effects of serum potassium on prescription of the full guideline recommended daily dose of 50 mg in real‐world daily practice are unknown. Therefore, we investigated serum potassium and its association with the prescribed MRA dose in a large cohort of chronic HF patients. Methods and results A total of 5346 patients with chronic HF with a left ventricular ejection fraction ≤40% from 34 Dutch outpatient HF clinics between 2013 and 2016 were analysed on serum potassium and MRA (spironolactone and eplenerone) dose. Data were stratified by potassium as a serum potassium level <4.0, 4.0 to 5.0 or >5.0 mmol/L. Multivariable logistic regression models were used to assess the association between serum potassium and MRA dose and to adjust for potential confounders. Mean serum potassium was 4.4 ± 0.5 mmol/L and hyperkalaemia (serum potassium >5.0 mmol/L) was present in 399 patients (7.5%). MRA was used in 3091 patients (58.1%). Patients with hyperkalaemia significantly less often received ≥100% of the target dose (50 mg) compared with patients with a serum potassium between 4.0–5.0 mmol/L and <4.0 mmol/L (7.7% vs. 9.5% vs. 13.6% respectively, P = 0.0078). In the multivariable regression analyses, patients with hyperkalaemia were significantly less likely to receive ≥100% of the target dose compared with patients with serum potassium 4.0–5.0 mmol/L (OR 0.38, 95% CI 0.15–0.97, P = 0.044). Additionally, a one unit increase in serum potassium was significantly associated with a lower odds of receiving ≥100% of the target dose (OR 0.69, 95% CI 0.49–0.98, P = 0.036). Conclusions In this large registry of real‐world chronic HF patients, both an increase in serum potassium and hyperkalaemia were associated with a lower odds of receiving the guideline‐recommended MRA dose.https://doi.org/10.1002/ehf2.14285Heart failureHeart failure with reduced ejection fractionHyperkalaemiaMineralocorticoid receptor antagonistsRenin‐angiotensin‐aldosterone system inhibitorsGuidelines |
| spellingShingle | Pascal R. D. Clephas Sumant P. Radhoe Gerard C. M. Linssen Jorina Langerveld Jacobus Plomp Jeroen P. P. Smits Michiel J. Nagelsmit Hans‐Peter Brunner‐La Rocca Jasper J. Brugts Serum potassium level and mineralocorticoid receptor antagonist dose in a large cohort of chronic heart failure patients ESC Heart Failure Heart failure Heart failure with reduced ejection fraction Hyperkalaemia Mineralocorticoid receptor antagonists Renin‐angiotensin‐aldosterone system inhibitors Guidelines |
| title | Serum potassium level and mineralocorticoid receptor antagonist dose in a large cohort of chronic heart failure patients |
| title_full | Serum potassium level and mineralocorticoid receptor antagonist dose in a large cohort of chronic heart failure patients |
| title_fullStr | Serum potassium level and mineralocorticoid receptor antagonist dose in a large cohort of chronic heart failure patients |
| title_full_unstemmed | Serum potassium level and mineralocorticoid receptor antagonist dose in a large cohort of chronic heart failure patients |
| title_short | Serum potassium level and mineralocorticoid receptor antagonist dose in a large cohort of chronic heart failure patients |
| title_sort | serum potassium level and mineralocorticoid receptor antagonist dose in a large cohort of chronic heart failure patients |
| topic | Heart failure Heart failure with reduced ejection fraction Hyperkalaemia Mineralocorticoid receptor antagonists Renin‐angiotensin‐aldosterone system inhibitors Guidelines |
| url | https://doi.org/10.1002/ehf2.14285 |
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