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Hyperkalemia and Treatment With RAAS Inhibitors During Acute Heart Failure Hospitalizations and Their Association With Mortality.

Publication ,  Journal Article
Beusekamp, JC; Tromp, J; Cleland, JGF; Givertz, MM; Metra, M; O'Connor, CM; Teerlink, JR; Ponikowski, P; Ouwerkerk, W; van Veldhuisen, DJ ...
Published in: JACC Heart Fail
November 2019

OBJECTIVES: This study investigated associations between incident hyperkalemia during acute heart failure (HF) hospitalizations and changes in renin-angiotensin-aldosterone system (RAAS) inhibitors. BACKGROUND: Hyperkalemia is a potential complication of RAAS inhibitors. For patients with HF, fear of hyperkalemia may lead to failure to deliver guideline-recommended doses of RAAS inhibitors. METHODS: Serum potassium concentrations were measured daily from baseline (<24 h after admission) until discharge or day 7 in 1,589 patients enrolled in the PROTECT (Placebo-Controlled Randomized Study of the Selective A1 Adenosine Receptor Antagonist Rolofylline for Patients Hospitalized with Acute Decompensated Heart Failure and Volume Overload to Assess Treatment Effect on Congestion and Renal Function) trial. Incident hyperkalemia was defined as at least 1 episode of potassium >5.0 mEq/l. The primary outcome was all-cause mortality at 180 days. RESULTS: Overall, serum potassium concentrations increased from 4.3 ± 0.6 mEq/l at baseline to 4.5 ± 0.6 mEq/l at discharge or day 7 (p < 0.001). Patients developing incident hyperkalemia (n = 564; 35%) were more often taking mineralocorticoid antagonists (MRAs) therapy prior to hospitalization and were more likely to have them down-titrated during hospitalization, independent of confounders. Incident hyperkalemia was not associated with adverse outcomes. Yet, down-titration of MRAs during hospitalization was independently associated with 180-day mortality (hazard ratio [HR]: 1.73; 95% confidence interval [CI]: 1.15 to 2.60), regardless of incident hyperkalemia (pinteraction >0.10). Patients with incident hyperkalemia who were discharged with the same or increased dose of MRAs (HR: 0.52; 95% CI: 0.32 to 0.85) or angiotensin-converting enzyme (ACE) inhibitors/angiotensin receptor blockers (ARBs) (HR: 0.47; 95% CI: 0.29 to 0.77) had a lower 180-day mortality. CONCLUSIONS: Incident hyperkalemia is common in patients hospitalized for acute HF and is not associated with adverse outcomes. Incident hyperkalemia is associated with down-titration of MRAs, but patients who maintained or increased their dose of MRAs and/or ACE inhibitors/ARB during acute HF hospitalization had better 180-day survival.

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Published In

JACC Heart Fail

DOI

EISSN

2213-1787

Publication Date

November 2019

Volume

7

Issue

11

Start / End Page

970 / 979

Location

United States

Related Subject Headings

  • Renin-Angiotensin System
  • Mineralocorticoid Receptor Antagonists
  • Middle Aged
  • Male
  • Hyperkalemia
  • Humans
  • Hospitalization
  • Heart Failure
  • Female
  • Angiotensin-Converting Enzyme Inhibitors
 

Citation

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Beusekamp, J. C., Tromp, J., Cleland, J. G. F., Givertz, M. M., Metra, M., O’Connor, C. M., … van der Meer, P. (2019). Hyperkalemia and Treatment With RAAS Inhibitors During Acute Heart Failure Hospitalizations and Their Association With Mortality. JACC Heart Fail, 7(11), 970–979. https://doi.org/10.1016/j.jchf.2019.07.010
Beusekamp, Joost C., Jasper Tromp, John G. F. Cleland, Michael M. Givertz, Marco Metra, Christopher M. O’Connor, John R. Teerlink, et al. “Hyperkalemia and Treatment With RAAS Inhibitors During Acute Heart Failure Hospitalizations and Their Association With Mortality.JACC Heart Fail 7, no. 11 (November 2019): 970–79. https://doi.org/10.1016/j.jchf.2019.07.010.
Beusekamp JC, Tromp J, Cleland JGF, Givertz MM, Metra M, O’Connor CM, et al. Hyperkalemia and Treatment With RAAS Inhibitors During Acute Heart Failure Hospitalizations and Their Association With Mortality. JACC Heart Fail. 2019 Nov;7(11):970–9.
Beusekamp, Joost C., et al. “Hyperkalemia and Treatment With RAAS Inhibitors During Acute Heart Failure Hospitalizations and Their Association With Mortality.JACC Heart Fail, vol. 7, no. 11, Nov. 2019, pp. 970–79. Pubmed, doi:10.1016/j.jchf.2019.07.010.
Beusekamp JC, Tromp J, Cleland JGF, Givertz MM, Metra M, O’Connor CM, Teerlink JR, Ponikowski P, Ouwerkerk W, van Veldhuisen DJ, Voors AA, van der Meer P. Hyperkalemia and Treatment With RAAS Inhibitors During Acute Heart Failure Hospitalizations and Their Association With Mortality. JACC Heart Fail. 2019 Nov;7(11):970–979.
Journal cover image

Published In

JACC Heart Fail

DOI

EISSN

2213-1787

Publication Date

November 2019

Volume

7

Issue

11

Start / End Page

970 / 979

Location

United States

Related Subject Headings

  • Renin-Angiotensin System
  • Mineralocorticoid Receptor Antagonists
  • Middle Aged
  • Male
  • Hyperkalemia
  • Humans
  • Hospitalization
  • Heart Failure
  • Female
  • Angiotensin-Converting Enzyme Inhibitors