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
Why the study?
The authors hypothesized that hyperkalaemia-associated increased mortality in chronic heart failure may be related to renin-angiotensin-aldosterone system inhibitor withdrawal.
Does hyperkalaemia increase mortality in chronic heart failure patients independently of RAAS inhibitor discontinuation?
Population
9222 outpatients with chronic heart failure across 31 countries
Comparison
Hyperkalaemia and RAASi use, dose, or discontinuation
Design
Multinational registry-based cohort study
Follow-up
Median 12.2 months
Authors
Discussion
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Member takes
Implication
HK-associated mortality may reflect RAASi discontinuation rather than direct harm; leaves open whether continuing RAASi improves survival.
Structured PICO
Does hyperkalaemia increase mortality in chronic heart failure patients independently of RAAS inhibitor discontinuation?
P
Population
9,222 outpatients with chronic heart failure (HFrEF 60.6%, HFmrEF 22.9%, HFpEF 16.5%), multinational (31 countries).
I
Intervention
Hyperkalaemia (≥5.0 mmol/L) and RAAS inhibitor discontinuation
C
Comparator
Normokalaemia and RAAS inhibitor continuation
O
Outcome
All-cause or cardiovascular death at median 12.2 months follow-uphard clinical
In patients with chronic heart failure, the increased mortality associated with hyperkalaemia appears to be driven by the subsequent discontinuation of life-saving RAAS inhibitors rather than the hyperkalaemia itself.
Cite This Study
Rossignol et al. (2020) studied this question.