Hyperkalemia in heart failure patients in Spain and its impact on guidelines and recommendations: ESC-EORP-HFA Heart Failure Long-Term Registry

Crespo‐Leiro, María G.; Barge‐Caballero, Eduardo; Segovia‐Cubero, Javier; González-Costello, José; López-Fernández, Silvia; García‐Pinilla, José Manuel; Almenar‐Bonet, Luis; Juan-Bagudá, Javier de; Roig-Minguell, Eulalia; Bayés‐Genís, Antoni; Sanz-Julve, Marisa; Lambert-Rodríguez, José Luis; Lara-Padrón, Antonio; Pérez-Ruiz, José María; Marquina, Carla Fernández-Vivancos; Fuente-Galán, Luis de la; Román, Alfonso Varela; Torres-Calvo, Francisco; Andrés-Novales, Javier; Escudero-González, Aida; Pascual-Figal, Domingo A.; Ridocci-Soriano, Francisco; Sahuquillo-Martínez, Ana; Bierge-Valero, David; Epelde-Gonzalo, F.; Gallego-Page, Juan Carlos; Dalmau, Regina; Bover-Freire, Ramón; Quiles-Granado, Juan; Maggioni, Aldo P.; Lund, Lars H.; Muñiz, Javier; Delgado-Jiménez, Juan

doi:10.1016/j.rec.2019.05.015

Cited by 14 publications

(29 citation statements)

References 30 publications

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“…According to the prevalence of chronic HF patients with GFR ≥ 30 mL/min/1.73 m² described by Crespo-Lerio [ 23 ], we estimated the number of HF patients with the combination of EF ≤ 40%, NYHA functional class II–IV, and GFR ≥ 30 mL/min/1.73 m² ( Table 6 ). In Spain, an estimated 245,789 (95% CI: 244,819–246,762) patients would have these characteristics.…”

Section: Resultsmentioning

confidence: 99%

“…We used the 6.1% prevalence of GFR < 30 mL/min/1.73 m² among chronic HF patients, reported by Crespo-Leiro et al [ 23 ], based on data from 28 Spanish hospitals included in the ESC Heart Failure Long-Term Registry. This is the most recent publication with HF data from Spain, includes the largest series of Spanish patients, and is the only study to provide GFR data generalizable to the HF population.…”

Section: Discussionmentioning

confidence: 99%

“…To this end, we selected articles that contained the terms ‘‘heart failure’’ in the title; ‘‘prevalence’’ or ‘‘burden’’ in the title or abstract; ‘‘ejection fraction’’, ‘‘systole’’, or ‘‘systolic’’ in the title or abstract; and ‘‘general population’’ or ‘‘healthy’’ in the title or abstract (search date: September 1, 2017). This systematic search was updated on April 15, 2020, and supplemented with articles provided by experts [ 12 , 13 , 20 , 21 , 22 , 23 , 24 ].…”

Section: Methodsmentioning

confidence: 99%

“…The proportion of patients with GFR ≥ 30 mL/min/1.73 m² was estimated from the most generalizable data, obtained from patients with chronic HF in 28 Spanish hospitals included in the European Society of Cardiology (ESC) Heart Failure Long-Term Registry [ 23 ]. The prevalence of GFR ≥ 30 mL/min/1.73 m² was applied to the estimated HF population with EF ≤ 40% and with NYHA functional class II–IV (obtained in Section 2.3 ).…”

Section: Methodsmentioning

confidence: 99%

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Estimated Population Prevalence of Heart Failure with Reduced Ejection Fraction in Spain, According to DAPA-HF Study Criteria

Camps

Delgado-Jiménez

Farré

et al. 2020

JCM

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Heart failure (HF) is one of the main causes of morbidity, mortality, and high healthcare costs. Dapagliflozin, a sodium-glucose cotransporter-2 (SGLT2) inhibitor, reduced cardiovascular mortality and hospitalization for HF compared to placebo in patients with chronic HF, and reduced ejection fraction (EF) in the Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure (DAPA-HF) study. Our aim was to estimate the number of patients with DAPA-HF characteristics in Spain. Our literature review identified epidemiological studies whose objective was to quantify the prevalence of HF and its comorbidities in Spain. We estimated the prevalence of HF with reduced EF, of New York Heart Association (NYHA) functional class II–IV, and with a glomerular filtration rate (GFR) ≥ 30 mL/min/1.73 m². In this population, we analysed the prevalence of diabetes using data from the REDINSCOR (Spanish Network for Heart Failure) registry. Our estimations indicate there are 594,684 patients ≥45 years old with HF in Spain (2.6% of this population age group), of which 52.4%, 84.0%, and 93.9% have reduced EF, are NYHA II–IV, and have a GFR ≥ 30 mL/min/1.73 m², respectively. By our calculations, approximately 245,789 Spanish patients would meet the DAPA-HF patient profile, and therefore could benefit from the protective cardiovascular effects of dapagliflozin.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Estimated Population Prevalence of Heart Failure with Reduced Ejection Fraction in Spain, According to DAPA-HF Study Criteria

Camps

Delgado-Jiménez

Farré

et al. 2020

JCM

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“…For example, there is the case of persistent congestion (which increases mortality, hospitalisation, hospital stay, rehospitalisation and resistance to loop diuretics) [8][9][10][11] or hyperpotassaemia (which, in addition to increasing mortality, limits the use of diseasemodifying drugs, such as renin-angiotensin-aldosterone system (RAAS) blockers or mineralocorticoid-receptor antagonists (MRAs). 12,13 Another comorbidity usually present is anaemia, thereby adding complexity to diagnostic and therapeutic management since it may be due to multiple conditions such as deficit in iron, cobalamins or folates, altered renal perfusion, reduced erythropoietin production or a situation of haemodilution due to congestion, all of which may be isolated occurrences or in combination.…”

Section: Introductionmentioning

confidence: 99%

The CRAS-EAHFE study: Characteristics and prognosis of acute heart failure episodes with cardiorenal-anaemia syndrome at the emergency department

Llauger

Jacob

Herrero‐Puente

et al. 2020

European Heart Journal. Acute Cardiovascular Care

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Background The coexistence of other comorbidities confers poor outcomes in patients with acute heart failure. Our aim was to determine the characteristics of patients with acute heart failure and cardiorenal anaemia syndrome and the relationship between renal dysfunction and anaemia, alone or combined as cardiorenal anaemia syndrome, on short-term outcomes. Methods We analysed the Epidemiology of Acute Heart Failure in Emergency Departments registry (cohort of patients with acute heart failure in Spanish emergency departments). Renal dysfunction was defined by an estimated glomerular filtration rate <60 ml/min/m2, anaemia by haemoglobin values <12/<13 g/dl in women/men, and cardiorenal anaemia syndrome as the presence of both. Comparisons were made according to cardiorenal-anaemia syndrome positive (CRAS+) with respect to the rest of patients (CRAS–) and according the presence of renal dysfunction (RD+) and anaemia (A+), (alone, RD+/A–, RD–/A+) or in combination (RD+/A+; i.e. CRAS+) with respect to patients without renal dysfunction and anaemia (RD–/A–). The primary outcome was 30-day mortality, and the secondary outcomes were need for admission, prolonged hospitalisation (>10 days), in-hospital mortality during the index event, and reconsultation and the combination of 30-day post-discharge reconsultation/death. These short-term outcomes were compared and adjusted for differences among groups. Results Of the 13,307 patients analysed, CRAS+ (36.4%) was associated with older age, multiple comorbidities, chronic use of loop diuretics, oedemas and hypotension. The 30-day mortality in CRAS+ was greater than in CRAS– (hazard ratio = 1.46, 95% confidence interval = 1.26–1.68) and RD–/A– (hazard ratio = 1.83, 95% confidence interval = 1.46–2.28) control groups. The mortality level was also higher in RD+/A– (hazard ratio = 1.40, 95% confidence interval = 1.10–1.78) and higher, but not statistically significant, in RD–/A+ (hazard ratio = 1.28, 95% confidence interval = 0.99–1.63) with respect to RD–/A–. All of the secondary outcomes, when related to CRAS– and RD–/A– control groups, were worse for CRAS+ and to a lesser extent, RD+/A–, being more rarely observed in RD–/A+. Conclusions Cardiorenal anaemia syndrome in acute heart failure is related to greater mortality and worse short-term outcomes, and the impact of renal dysfunction and anaemia seems to be additive.

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Experience with the potassium binder patiromer in hyperkalaemia management in heart failure patients in real life

et al. 2022

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Aims Hyperkalaemia (HK) is common in heart failure (HF) patients, related to renal dysfunction and medical treatment. It limits medical therapy optimization, which impacts prognosis. New potassium (K) binders help control HK, allowing better medical management of HF. Methods and results A retrospective multicentre register included all outpatients with HF and HK (K ≥ 5.1 mEq/L) treated with patiromer according to current recommendations. We evaluated analytic and clinical parameters before starting the treatment and at 7, 30 and 90 days, as well as adverse events related to patiromer and treatment optimization. We included 74 patients (71.6% male) with a mean age of 70.8 years (SD 9.2). Sixty-seven patients (90.5%) presented HK in the previous year. Forty patients (54.1%) underwent down-titration of a renin-angiotensin-aldosterone inhibitor (RAASi) or a mineralocorticoid receptor antagonist (MRA), and 27 (36.5%) stopped any of them due to HK. Initial K was 5.5 mEq/L (SD 0.6), with a significantly reduction at 7 days (4.9 mEq/L (SD 0.8); P < 0.001), maintained at 90 days (4.9 mEq/L (SD 0.8); P < 0.001). There were no other electrolyte disturbances, with a slight improvement in renal function [glomerular filtration rate 39.6 mL/min (SD 20.4) to 42.7 mL/min (SD 23.2); P = 0.005]. Adverse events were reported in 33.9% of patients, the most common being hypomagnesaemia (16.3%), gastrointestinal disturbances (14.9%) and HK (2.8%). Withdrawal of patiromer was uncommon (12.2%) due to gastrointestinal disturbances in 66.7% of cases. Nine patients (12.2%) started on a RAASi, and 15 patients (20.3%) on an MRA during the follow-up. Forty-five patients (60.8%) increased the dose of RAASi or MRA, increasing to target doses in 5.4 and 10.8% of patients, respectively. At 90 days, NTproBNP values were reduced from 2509.5 pg/mL [IQR 1311-4,249] to 1396.0 pg/mL ; P = 0.003, but the reduction was only observed in those who optimized HF medical treatment [NTproBNP from 1950.5 pg/mL (IQR 1208-3403) to 1349.0 pg/mL (IQR 804-2609); P < 0.01]. NYHA functional class only improved in 7.5% of patients, corresponding with those who optimized HF medical treatment. Compared with the previous 3 months before patiromer treatment, the rate of hospitalization was reduced from 28.4 to 10.9% (P < 0.01), and the emergency room visits from 18.9 to 5.4% (P < 0.01). Conclusions In a real-life cohort of patients with HF, patiromer reduced and maintained K levels during 3 months of followup. The most common adverse events were hypomagnesaemia and gastrointestinal disturbances. Patiromer helps optimize medical treatment, increasing the percentage of patients treated with RAASi and MRA at target doses. At the end of follow-up, natriuretic peptides values and hospital visits were reduced, suggesting the benefit of optimizing HF medical treatment.

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Hyperkalemia in heart failure patients in Spain and its impact on guidelines and recommendations: ESC-EORP-HFA Heart Failure Long-Term Registry

Abstract: Hiperpotasemia en pacientes con insuficiencia cardiaca en España y su impacto en las recomendaciones. Registro ESC-EORP-HFA Heart Failure Long-Term

Cited by 14 publications

References 30 publications

Estimated Population Prevalence of Heart Failure with Reduced Ejection Fraction in Spain, According to DAPA-HF Study Criteria

Estimated Population Prevalence of Heart Failure with Reduced Ejection Fraction in Spain, According to DAPA-HF Study Criteria

The CRAS-EAHFE study: Characteristics and prognosis of acute heart failure episodes with cardiorenal-anaemia syndrome at the emergency department

Experience with the potassium binder patiromer in hyperkalaemia management in heart failure patients in real life

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