RT Journal Article
T1 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.
A1 Rossignol, Patrick
A1 Lainscak, Mitja
A1 Crespo-Leiro, Maria G
A1 Laroche, Cécile
A1 Piepoli, Massimo F
A1 Filippatos, Gerasimos
A1 Rosano, Giuseppe M C
A1 Savarese, Gianluigi
A1 Anker, Stefan D
A1 Seferovic, Petar M
A1 Ruschitzka, Frank
A1 Coats, Andrew J S
A1 Mebazaa, Alexandre
A1 McDonagh, Theresa
A1 Sahuquillo, Ana
A1 Penco, Maria
A1 Maggioni, Aldo P
A1 Lund, Lars H
A1 Heart Failure Long-Term Registry Investigators Group, 
K1 Heart failure
K1 Hyperkalaemia
K1 Hypokalaemia
K1 Mineralocorticoid receptor antagonists
K1 Prognosis
K1 Renin-angiotensin-aldosterone system inhibitors
AB 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.
YR 2020
FD 2020-04-03
LK https://hdl.handle.net/10668/25920
UL https://hdl.handle.net/10668/25920
LA en
DS RISalud
RD Apr 14, 2025