Prognostic significance of serum potassium in patients hospitalized for acute heart failure

In the last years, major progress occurred in heart failure (HF) management. Quadruple therapy is now mandatory for all the patients with HF with reduced ejection fraction. Whilst verciguat is becoming available across several countries, omecamtiv mecarbil is waiting to be released for clinical use. Concurrent use of potassium-lowering agents may counteract hyperkalaemia and facilitate renin-angiotensin-aldosterone system inhibitor implementations. The results of the EMPagliflozin outcomE tRial in Patients With chrOnic heaRt Failure With Preserved Ejection Fraction (EMPEROR-Preserved) trial were confirmed by the Dapagliflozin in Heart Failure with Mildly Reduced or Preserved Ejection Fraction (DELIVER) trial, and we now have, for the first time, evidence for treatment of also patients with HF with preserved ejection fraction. In a pre-specified meta-analysis of major randomized controlled trials, sodium-glucose co-transporter-2 inhibitors reduced all-cause mortality, cardiovascular (CV) mortality, and HF hospitalization in the patients with HF regardless of left ventricular ejection fraction. Other steps forward have occurred in the treatment of decompensated HF. Acetazolamide in Acute Decompensated Heart Failure with Volume Overload (ADVOR) trial showed that the addition of intravenous acetazolamide to loop diuretics leads to greater decongestion vs. placebo. The addition of hydrochlorothiazide to loop diuretics was evaluated in the CLOROTIC trial. Torasemide did not change outcomes, compared with furosemide, in TRANSFORM-HF. Ferric derisomaltose had an effect on the primary outcome of CV mortality or HF rehospitalizations in IRONMAN (rate ratio 0.82; 95% confidence interval 0.66-1.02; P = 0.070). Further options for the treatment of HF, including device therapies, cardiac contractility modulation, and percutaneous treatment of valvulopathies, are summarized in this article.

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“…Both hypokalaemia and hyperkalaemia have been associated with worse prognosis 27,28 . Cooper et al .…”

Section: Diagnosis and Prognosismentioning

confidence: 99%

Heart failure: an update from the last years and a look at the near future

et al. 2022

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“…Hypokalemia at discharge in patients with acute HFpEF was associated with neither all-cause mortality nor composite events of mortality and HF-related events. 23 The SwedeHF registry demonstrated that new-onset hypokalemia was not associated with HF hospitalization in patients with HF whose baseline serum potassium concentrations were 3.5-5.0 mmol/L, although 20.3% of patients experienced at least one episode of hypokalemia. 25 Concurrently, Nishihara et al have reported that the lowest K + quartile (K + <4.1 mmol/L) at discharge was associated with cardiovascular events in patients with HFpEF.…”

Section: Hypokalemia and Hf-related Eventsmentioning

confidence: 98%

Hypokalemia, Kidney Function, and Clinical Outcomes in Heart Failure With Preserved Ejection Fraction

Otaki,

Watanabe,

Yamaguchi

et al. 2023

Circ J

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Background: Heart failure with preserved ejection fraction (HFpEF) is an increasing health problem associated with high morbidity and mortality rates. Several reports have shown an association between hypokalemia and clinical outcomes in patients with heart failure (HF). However, the association of hypokalemia with kidney function and clinical outcomes in patients with HFpEF remains unclear. Methods and Results:We measured serum potassium levels and kidney function in 454 patients with HFpEF (mean age 76 years; 55% men) at admission. Hypokalemia (K + <3.5 mmol/L) and hyperkalemia (K + >5.0 mmol/L) were identified in 58 (12.7%) and 11 (2.4%) patients, respectively. Patients with hypokalemia showed renal tubular damage (RTD), defined as a urinary β2-microglobulin to creatinine ratio ≥300 μg/gCr, preserved estimated glomerular filtration rate (eGFR), and plasma volume expansion. Multivariate logistic analysis demonstrated that RTD, preserved eGFR, and plasma volume expansion were significantly associated with hypokalemia. During the median follow-up period of 1,000 days, 82 HF-related events occurred. Kaplan-Meier analysis showed that patients with hypokalemia had a higher rate of HF-related events than those without hypokalemia. Multivariate Cox proportional hazard regression analysis demonstrated that hypokalemia was significantly associated with HF-related events after adjusting for confounding factors. Conclusions:Hypokalemia is affected by kidney function, notably RTD, in patients with HFpEF. Hypokalemia is a risk factor for HF-related events in patients with HFpEF.

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“…Common side effects or complications of loop diuretics include renal dysfunction [43] and electrolyte abnormalities (hyponatraemia, hypokalaemia, hypochloraemia, and metabolic alkalosis) [44][45][46][47], all of which are associated with worse outcomes. In particular, renal dysfunction and hypochloraemia (amongst other mechanisms) may contribute to loop diuretic resistance [48,49].…”

Section: Loop Diureticsmentioning

confidence: 99%

Diuretic Treatment in Patients with Heart Failure: Current Evidence and Future Directions – Part I: Loop Diuretics

Cuthbert,

Clark

2024

Curr Heart Fail Rep

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Purpose of Review Fluid retention or congestion is a major cause of symptoms, poor quality of life, and adverse outcome in patients with heart failure (HF). Despite advances in disease-modifying therapy, the mainstay of treatment for congestion—loop diuretics—has remained largely unchanged for 50 years. In these two articles (part I: loop diuretics and part II: combination therapy), we will review the history of diuretic treatment and the current trial evidence for different diuretic strategies and explore potential future directions of research. Recent Findings We will assess recent trials including DOSE, TRANSFORM, ADVOR, CLOROTIC, OSPREY-AHF, and PUSH-AHF amongst others, and assess how these may influence current practice and future research. Summary There are few data on which to base diuretic therapy in clinical practice. The most robust evidence is for high dose loop diuretic treatment over low-dose treatment for patients admitted to hospital with HF, yet this is not reflected in guidelines. There is an urgent need for more and better research on different diuretic strategies in patients with HF.

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Prognostic significance of serum potassium in patients hospitalized for acute heart failure

Cited by 9 publications

References 28 publications

Heart failure: an update from the last years and a look at the near future

Heart failure: an update from the last years and a look at the near future

Hypokalemia, Kidney Function, and Clinical Outcomes in Heart Failure With Preserved Ejection Fraction

Diuretic Treatment in Patients with Heart Failure: Current Evidence and Future Directions – Part I: Loop Diuretics

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