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Unravelling the interplay between hyperkalaemia, renin-angiotensin-aldosterone inhibitor use and clinical outcomes. Data from 9222 chronic heart failure patients of the ESC-HFA-EORP Heart Failure Long-Term Registry.
- Source :
-
European Journal of Heart Failure . Aug2020, Vol. 22 Issue 8, p1378-1389. 12p. 1 Chart, 5 Graphs. - Publication Year :
- 2020
-
Abstract
- <bold>Aims: </bold>We assessed the interplay between hyperkalaemia (HK) and renin-angiotensin-aldosterone system inhibitor (RAASi) use, dose and discontinuation, and their association with all-cause or cardiovascular death in patients with chronic heart failure (HF). We hypothesized that HK-associated increased death may be related to RAASi withdrawal.<bold>Methods and Results: </bold>The ESC-HFA-EORP Heart Failure Long-Term Registry was used. Among 9222 outpatients (HF with reduced ejection fraction: 60.6%, HF with mid-range ejection fraction: 22.9%, HF with preserved ejection fraction: 16.5%) from 31 countries, 16.6% had HK (≥5.0 mmol/L) at baseline. Angiotensin-converting enzyme inhibitor (ACEi) or angiotensin receptor blocker (ARB) was used in 88.3%, a mineralocorticoid receptor antagonist (MRA) in 58.7%, or a combination in 53.2%; of these, at ≥50% of target dose in ACEi: 61.8%; ARB: 64.7%; and MRA: 90.3%. At a median follow-up of 12.2 months, there were 789 deaths (8.6%). Both hypokalaemia and HK were independently associated with higher mortality, and ACEi/ARB prescription at baseline with lower mortality. MRA prescription was not retained in the model. In multivariable analyses, HK at baseline was independently associated with MRA non-prescription at baseline and subsequent discontinuation. When considering subsequent discontinuation of RAASi (instead of baseline use), HK was no longer found associated with all-cause deaths. Importantly, all RAASi (ACEi, ARB, or MRA) discontinuations were strongly associated with mortality.<bold>Conclusions: </bold>In HF, hyper- and hypokalaemia were associated with mortality. However, when adjusting for RAASi discontinuation, HK was no longer associated with mortality, suggesting that HK may be a risk marker for RAASi discontinuation rather than a risk factor for worse outcomes. [ABSTRACT FROM AUTHOR]
- Subjects :
- *ALDOSTERONE antagonists
*HEART failure patients
*RENIN-angiotensin system
*MINERALOCORTICOID receptors
*ACE inhibitors
*ANGIOTENSIN receptors
*RENIN
*RESEARCH
*ANGIOTENSINS
*RESEARCH methodology
*ACQUISITION of data
*MEDICAL cooperation
*EVALUATION research
*COMPARATIVE studies
*HYPERKALEMIA
*ALDOSTERONE
*HEART failure
Subjects
Details
- Language :
- English
- ISSN :
- 13889842
- Volume :
- 22
- Issue :
- 8
- Database :
- Academic Search Index
- Journal :
- European Journal of Heart Failure
- Publication Type :
- Academic Journal
- Accession number :
- 145967664
- Full Text :
- https://doi.org/10.1002/ejhf.1793