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Association between potassium level and outcomes in heart failure with reduced ejection fraction: a cohort study from the Swedish Heart Failure Registry.

Publication ,  Conference
Cooper, LB; Benson, L; Mentz, RJ; Savarese, G; DeVore, AD; Carrero, J-J; Dahlström, U; Anker, SD; Lainscak, M; Hernandez, AF; Pitt, B; Lund, LH
Published in: Eur J Heart Fail
August 2020

AIMS: Hyperkalaemia and hypokalaemia are common in heart failure and associated with worse outcomes. However, the optimal potassium range is unknown. We sought to determine the optimal range of potassium in patients with heart failure and reduced ejection fraction (< 40%) by exploring the relationship between baseline potassium level and short- and long-term outcomes using the Swedish Heart Failure Registry from 1 January 2006 to 31 December 2012. METHODS AND RESULTS: We assessed the association between baseline potassium level and all-cause mortality at 30 days, 12 months, and maximal follow-up, in uni- and multivariable stratified and restricted cubic spline Cox regressions. Of 13 015 patients, 93.3% had potassium 3.5-5.0 mmol/L, 3.7% had potassium <3.5 mmol/L, and 3.0% had potassium >5.0 mmol/L. Potassium <3.5 mmol/L and >5.0 mmol/L were more common with lower estimated glomerular filtration rate and heart failure of longer duration and greater severity. The potassium level associated with the lowest hazard risk for mortality at 30 days, 12 months, and maximal follow-up was 4.2 mmol/L, and there was a steep increase in risk with both higher and lower potassium levels. In adjusted strata analyses, lower potassium was independently associated with all-cause mortality at 12 months and maximal follow-up, while higher potassium levels only increased risk at 30 days. CONCLUSION: In this nationwide registry, the relationship between potassium and mortality was U-shaped, with an optimal potassium value of 4.2 mmol/L. After multivariable adjustment, hypokalaemia was associated with increased long-term mortality but hyperkalaemia was associated with increased short-term mortality.

Duke Scholars

Published In

Eur J Heart Fail

DOI

EISSN

1879-0844

Publication Date

August 2020

Volume

22

Issue

8

Start / End Page

1390 / 1398

Location

England

Related Subject Headings

  • Sweden
  • Stroke Volume
  • Registries
  • Potassium
  • Humans
  • Heart Failure
  • Cohort Studies
  • Cardiovascular System & Hematology
  • 3201 Cardiovascular medicine and haematology
  • 1102 Cardiorespiratory Medicine and Haematology
 

Citation

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MLA
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Cooper, L. B., Benson, L., Mentz, R. J., Savarese, G., DeVore, A. D., Carrero, J.-J., … Lund, L. H. (2020). Association between potassium level and outcomes in heart failure with reduced ejection fraction: a cohort study from the Swedish Heart Failure Registry. In Eur J Heart Fail (Vol. 22, pp. 1390–1398). England. https://doi.org/10.1002/ejhf.1757
Cooper, Lauren B., Lina Benson, Robert J. Mentz, Gianluigi Savarese, Adam D. DeVore, Juan-Jesus Carrero, Ulf Dahlström, et al. “Association between potassium level and outcomes in heart failure with reduced ejection fraction: a cohort study from the Swedish Heart Failure Registry.” In Eur J Heart Fail, 22:1390–98, 2020. https://doi.org/10.1002/ejhf.1757.
Cooper LB, Benson L, Mentz RJ, Savarese G, DeVore AD, Carrero J-J, et al. Association between potassium level and outcomes in heart failure with reduced ejection fraction: a cohort study from the Swedish Heart Failure Registry. In: Eur J Heart Fail. 2020. p. 1390–8.
Cooper, Lauren B., et al. “Association between potassium level and outcomes in heart failure with reduced ejection fraction: a cohort study from the Swedish Heart Failure Registry.Eur J Heart Fail, vol. 22, no. 8, 2020, pp. 1390–98. Pubmed, doi:10.1002/ejhf.1757.
Cooper LB, Benson L, Mentz RJ, Savarese G, DeVore AD, Carrero J-J, Dahlström U, Anker SD, Lainscak M, Hernandez AF, Pitt B, Lund LH. Association between potassium level and outcomes in heart failure with reduced ejection fraction: a cohort study from the Swedish Heart Failure Registry. Eur J Heart Fail. 2020. p. 1390–1398.
Journal cover image

Published In

Eur J Heart Fail

DOI

EISSN

1879-0844

Publication Date

August 2020

Volume

22

Issue

8

Start / End Page

1390 / 1398

Location

England

Related Subject Headings

  • Sweden
  • Stroke Volume
  • Registries
  • Potassium
  • Humans
  • Heart Failure
  • Cohort Studies
  • Cardiovascular System & Hematology
  • 3201 Cardiovascular medicine and haematology
  • 1102 Cardiorespiratory Medicine and Haematology