Hyperkalaemia in Acute Heart Failure: Patient Profiles, Predictors and Outcomes in an Asian Population

Background: Hyperkalaemia (HK) is a significant concern in patients with acute decompensated heart failure (ADHF) and has associated morbidity and mortality risks. Its impact on Asian populations remains underexplored. Methods: This observational study reviewed ADHF cases and compared patient profiles, acute in-hospital management and outcomes between patients with and without HK. Multivariate logistic regression identified predictors of in-hospital all-cause mortality in the HK cohort. Medications were assessed to identify treatment gaps. Heart failure (HF) readmissions and long-term all-cause mortality were evaluated after acute HF management. Results: Among 8,160 ADHF cases from January 2012 to December 2019 20.3% had HK. The HK cohort was older with higher comorbidity rates. Renin–angiotensin–aldosterone system inhibitors (RAASi) were underused on admission and discharge in the HK cohort (74.8% versus 78.8%; p<0.001) compared to the non-HK cohort (66.7% versus 76.1%; p<0.001). In-hospital mortality was higher in the HK cohort but not significantly different. In the HK cohort, independent risk factors for in-hospital all-cause mortality included prior HF hospitalisation (adjusted OR [aOR]18.227; 95% CI [2.037–163.096]), hyperbilirubinaemia (adjusted OR 1.013; 95% CI [1.003–1.023]), hyperuricaemia (adjusted OR 1.005; 95% CI [1.001–1.008]), dialysis (adjusted OR 10.899; 95% CI [2.918–40.716]), mechanical ventilation (adjusted OR 6.778; 95% CI [1.883–24.397]), cardiopulmonary resuscitation (adjusted OR 70.859; 95% CI [15.881–316.153]) and absence of loop diuretic (adjusted OR 12.931; [3.743–44.670]). HK patients had significantly lower long-term survival and more HF readmissions with log rank p<0.001 and p=0.007, respectively. RAASi use increased at follow-up with 22.3% HK incidence. Conclusion: Suboptimal use of guideline-directed medical therapies in HK patients contributes to higher morbidity and mortality in Asian patients with ADHF. Optimising HF treatment with newer potassium-lowering agents could improve clinical outcomes.