Key result
Managing hyperkalemia maximizes RAASi use and uptitration in HFrEF.
Why the study?
RAASi improves outcomes in HFrEF when titrated to maximally tolerated doses, but hyperkalemia and other side effects often lead to dose reduction or discontinuation and increased mortality risk.
Effective management of hyperkalemia and other side effects is essential to maximize RAASi dosing and improve survival in patients with HFrEF.
Hyperkalemia limits optimal RAASi dosing in HFrEF; leaves open the need for effective potassium management strategies.
Renin-angiotensin-aldosterone system inhibitors (RAASi) are known to improve outcomes in patients who have heart failure with reduced ejection fraction (HFrEF). To reduce mortality in these patients, RAASi should be uptitrated to the maximally tolerated dose. However, RAASi may also cause hyperkalemia. As a result of this side-effect, doses of RAASi are reduced, discontinued and seldom reinstated. Thus, the therapeutic target needed in these patients is often not reached because of hyperkalemia. Also, submaximal dosing of RAASi may be a result of symptomatic hypotension, syncope, hypoperfusion, reduced kidney function and other factors. The reduction of RAASi dose leads to adverse outcomes, such as an increased risk of mortality. Management of these side-effects is pivotal to maximise the use of RAASi in HFrEF, particularly in high-risk patients.
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Rosano et al. (2019) conducted a review in Heart failure with reduced ejection fraction (HFrEF). Renin-angiotensin-aldosterone system inhibitors (RAASi) was evaluated. Management of hyperkalemia is pivotal to maximize the use and uptitration of renin-angiotensin-aldosterone system inhibitors in patients with heart failure with reduced ejection fraction.
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