%0 Journal Article
%A Rossignol, Patrick
%A Lainscak, Mitja
%A Crespo-Leiro, Maria G
%A Laroche, Cécile
%A Piepoli, Massimo F
%A Filippatos, Gerasimos
%A Rosano, Giuseppe M C
%A Savarese, Gianluigi
%A Anker, Stefan D
%A Seferovic, Petar M
%A Ruschitzka, Frank
%A Coats, Andrew J S
%A Mebazaa, Alexandre
%A McDonagh, Theresa
%A Sahuquillo, Ana
%A Penco, Maria
%A Maggioni, Aldo P
%A Lund, Lars H
%A Heart Failure Long-Term Registry Investigators Group
%T 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.
%D 2020
%U https://hdl.handle.net/10668/25920
%X 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. 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. 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.
%K Heart failure
%K Hyperkalaemia
%K Hypokalaemia
%K Mineralocorticoid receptor antagonists
%K Prognosis
%K Renin-angiotensin-aldosterone system inhibitors
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