January 10, 2019Open Access
View Full PaperSerum Potassium and Clinical Outcomes in Heart Failure Patients: Results of Risk Calculations in 21 334 Patients in the UK
Key Result
Abnormal serum potassium exhibited a U-shaped association with mortality in incident heart failure, with increased risk for both <3.5 mmol/L (IRR 1.98; 95% CI 1.69-2.33) and ≥6.0 mmol/L (IRR 3.02).
Study Design
Type
Cohort (n=21,334)
Multicenter
Yes
Structured PICO
Do abnormal serum potassium levels increase the risk of mortality, major adverse cardiac events, and RAASi discontinuation in incident heart failure patients?
P
Population
21,334 newly diagnosed heart failure patients in the UK, with a first record between 2006 and 2015.
E
Exposure
Abnormal serum potassium levels (hypokalaemia <3.5 mmol/L, and hyperkalaemia ≥5.0, ≥5.5, and ≥6.0 mmol/L)
C
Comparator
Normal serum potassium levels (4.5 to <5.0 mmol/L)
O
Outcome
Mortality, major adverse cardiac events, and renin-angiotensin-aldosterone system inhibitor (RAASi) discontinuationhard clinical
Both hypokalaemia and hyperkalaemia are associated with increased mortality risk in new-onset heart failure patients, with hyperkalaemia also driving RAASi discontinuation.
Main Result
Relative Risk: 1.98 (95% CI 1.69–2.33)
Abstract
AIMS: At present, the clinical burden of hypokalaemia and hyperkalaemia among European heart failure patients, and relationships between serum potassium and adverse clinical outcomes in this population, is not well characterized. The aim of this study was to investigate associations between mortality, major adverse cardiac events, and renin-angiotensin-aldosterone system inhibitor (RAASi) discontinuation across serum potassium levels, in a UK cohort of incident heart failure patients. METHODS AND RESULTS: This was a retrospective observational cohort study of newly diagnosed heart failure patients listed in the Clinical Practice Research Datalink, with a first record of heart failure (index date) between 2006 and 2015. Hypokalaemia and hyperkalaemia episodes were defined as the number of serum potassium measurements exceeding each threshold (<3.5, ≥5.0, ≥5.5, and ≥6.0 mmol/L), without such a measurement in the preceding 7 days. Risk equations developed using Poisson generalized estimating equations were utilized to estimate adjusted incident rate ratios (IRRs) relating serum potassium and clinical outcomes (death, major adverse cardiac event, and RAASi discontinuation). Among 21,334 eligible heart failure patients, 1969 (9.2%), 7648 (35.9%), 2725 (12.8%), and 763 (3.6%) experienced episodes of serum potassium <3.5, ≥5.0, ≥5.5, and ≥6.0 mmol/L, respectively. The adjusted IRRs for mortality exhibited a U-shaped association pattern with serum potassium. Relative to the reference category (4.5 to <5.0 mmol/L), adjusted IRRs for mortality were estimated as 1.98 (95% confidence interval: 1.69-2.33), 1.23 (1.12-1.36), 1.35 (1.14-1.60), and 3.02 (2.28-4.02), for patients with serum potassium <3.5, ≥5.0 to <5.5, ≥5.5 to <6.0, and ≥6.0 mmol/L, respectively. The adjusted IRRs for major adverse cardiac events demonstrated a non-statistically significant relationship with serum potassium. Discontinuation of RAASi therapy exhibited a J-shaped trend in association with serum potassium. Compared with the reference category (4.5 to <5.0 mmol/L), adjusted IRRs were estimated as 1.07 (0.89-1.28) in patients with serum potassium <3.5 mmol/L, increasing to 1.32 (1.14-1.53) and 2.19 (1.63-2.95) among those with serum potassium ≥5.5 to <6.0 and ≥6.0 mmol/L, respectively. CONCLUSIONS: In UK patients with new onset heart failure, both hypokalaemia and hyperkalaemia were associated with increased mortality risk, and hyperkalaemia was associated with increased likelihood of RAASi discontinuation. Our results demonstrate the potential importance of serum potassium monitoring for heart failure outcomes and management.
Cite This Study
Linde et al. (Thu,) conducted a cohort in newly diagnosed heart failure (n=21,334). Abnormal serum potassium levels (<3.5 or ≥5.0 mmol/L) vs. Serum potassium 4.5 to <5.0 mmol/L was evaluated on Mortality (IRR 1.98, 95% CI 1.69-2.33). Abnormal serum potassium exhibited a U-shaped association with mortality in incident heart failure, with increased risk for both <3.5 mmol/L (IRR 1.98; 95% CI 1.69-2.33) and ≥6.0 mmol/L (IRR 3.02).