Associations of serum potassium levels with mortality in chronic heart failure patients

Abstract

Levels within the lower and upper levels of the normal serum potassium range (3.5-4.1 mmol/L and 4.8-5.0 mmol/L, respectively) were associated with a significant increased short-term risk of death in chronic heart failure patients. Likewise, potassium below 3.5 mmol/L and above 5.0 mmol/L was also associated with increased mortality.

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

“…We observed a J-shaped relationship between serum potassium and RAASi discontinuation with a small non-significant increase in RAASi discontinuation associated with hypokalaemia (<3.5 mmol/L) and greater (and statistically significant) increases in RAASi discontinuation associated with hyperkalaemia (≥5.5 mmol/L). While our results are broadly consistent with relationships observed in previous studies, 3,4,20,21 our approach to restrict patient time to a maximum of 30 days from each serum potassium measurement resulted in a more robust estimation of associations between hypokalaemia and hyperkalaemia and adverse clinical outcomes. Given the publicly funded nature of the UK health care system, the CPRD represents a large, Adjusted incident rate ratios for (A) death, (B) major adverse cardiac event, and (C) renin-angiotensin-aldosterone system inhibitor discontinuation as a function of serum potassium level in UK heart failure patients.…”

“…1 Both hypokalaemia and hyperkalaemia are considered burdensome electrolyte imbalances, associated with increased mortality and morbidity. [2][3][4] As a consequence of renal insufficiency, patients with heart failure (HF) are at increased risk of hyperkalaemia, and medications routinely prescribed for management of HF are known to further affect serum potassium levels. 5 In particular, combination therapy with renin-angiotensinaldosterone system inhibitor (RAASi) and/or mineralocorticoid receptor antagonist (MRA) agents, while recommended to reduce the incidence of hospitalization, 5 may further increase the risk of hyperkalaemia in this already-vulnerable population.…”

“…20 In a study of acute HF patients, serum potassium >4.6 mmol/L was associated with increased risk of 90 day mortality, 21 while chronic HF patients had an elevated all-cause mortality risk when serum potassium was >4.8 mmol/L. 4 Moreover, serum potassium levels were independently associated with mortality in HF patients following discharge from acute HF-related admissions. 3 Similar to our findings, a U-shaped relationship between mortality and serum potassium was reported, with higher mortality risk observed at low and high potassium values.…”

Potassium abnormalities in patients with heart failure from 11 Asian regions: insights from the ASIAN‐HF registry

“…Abnormalities in serum potassium concentrations (hypo‐ and hyperkalaemia) are common in patients with heart failure (HF) and associated with discontinuation or down‐titration of guideline‐recommended medical therapies and adverse outcomes . Therefore, current HF guidelines recommend frequent monitoring of serum potassium concentrations .…”

The year in cardiology 2017: heart failure

“…4 Recent data from the ESC HF Long-Term Registry (selected European sites) suggest that mineralocorticoid receptor antagonists (MRAs) are used in only two-third of patients with HFrEF 5,6 and in the non-selective Swedish HF Registry, in less than one-third. 7 Chronic kidney disease and hyperkalaemia are common in HF 8 and reasons for MRA under-use appear to be perceived risk of or actual hyperkalaemia and worsening renal function. 9 More novel drugs such as ivabradine and sacubitril/valsartan may be deferred due to clinician inertia, even though they have demonstrated benefit regardless of HF duration 10 and very early after initiation.…”