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Association between hypo- and hyperkalemia and outcome in acute heart failure patients: the role of medications.
- Source :
-
Clinical research in cardiology : official journal of the German Cardiac Society [Clin Res Cardiol] 2018 Mar; Vol. 107 (3), pp. 214-221. Date of Electronic Publication: 2017 Oct 28. - Publication Year :
- 2018
-
Abstract
- Background: The interaction between chronic medications on admission and the association between serum potassium level and outcome in patients with acute heart failure (AHF) are unknown.<br />Methods: Observational intercontinental study of patients admitted with AHF. 15954 patients were included from 12 cohorts in 4 continents. Main outcome was 90-day mortality. Clinical presentation (medication use, hemodynamics, comorbidities), demographic, echocardiographic, and biochemical data on admission were recorded prospectively in each cohort, with prospective adjudication of outcomes.<br />Results: Positive and negative linear relationships between 90-day mortality and sK+ above 4.5 mmol/L (hyperkalemia) and below 3.5 mmol/L (hypo-kalemia) were observed. Hazard ratio for death was 1.46 [1.34-1.58] for hyperkalemia and 1.22 [1.06-1.40] for hypokalemia. In a fully adjusted model, only hyperkalemia remained associated with mortality (HR 1.03 [1.02-1.04] for each 0.1 mmol/l change of sK+ above 4.5 mmol/L). Interaction tests revealed that the association between hyperkalemia and outcome was significantly affected by chronic medications. The association between hyperkalemia and mortality was absent for patients treated with beta blockers and in those with preserved renal function.<br />Conclusions: In patients with AHF, sK+ > 4.5 mmol/L appears to be associated with 90-day mortality. B-blockers have potentially a protective effect in the setting of hyperkalemia.
- Subjects :
- Acute Disease
Aged
Aged, 80 and over
Biomarkers blood
Europe epidemiology
Female
Follow-Up Studies
Heart Failure blood
Heart Failure drug therapy
Humans
Hyperkalemia mortality
Hyperkalemia prevention & control
Hypokalemia mortality
Hypokalemia prevention & control
Male
Middle Aged
Prospective Studies
Survival Rate trends
Time Factors
Treatment Outcome
United States epidemiology
Adrenergic beta-Antagonists therapeutic use
Heart Failure complications
Hyperkalemia etiology
Hypokalemia etiology
Potassium blood
Subjects
Details
- Language :
- English
- ISSN :
- 1861-0692
- Volume :
- 107
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Clinical research in cardiology : official journal of the German Cardiac Society
- Publication Type :
- Academic Journal
- Accession number :
- 29080909
- Full Text :
- https://doi.org/10.1007/s00392-017-1173-3