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Sarastri Y, Zebua JI, Lubis PN, Zahra F, Lubis AC. Admission hyponatraemia as heart failure events predictor in patients with acute heart failure. ESC Heart Fail 2023; 10:2966-2972. [PMID: 37519045 PMCID: PMC10567628 DOI: 10.1002/ehf2.14472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 04/17/2023] [Accepted: 07/02/2023] [Indexed: 08/01/2023] Open
Abstract
AIMS Heart failure remained consistent as one of the biggest cardiovascular problems in Indonesia. Hyponatraemia is a common electrolyte disorder among patients presented with heart failure; however, the prognostic value for worsening heart failure has not been well defined. METHODS AND RESULTS We studied 134 patients admitted with acute heart failure and investigated the relationship between admission serum sodium and the composite clinical outcomes of all-cause mortality and hospitalization ambispectively with a follow-up duration of 6 months. We also try to look for low sodium-level impacts in several conditions. Among 134 patients, 84 patients presented with low sodium during admission, defined as a serum sodium level of <135 mEq/L, and it was associated with higher composite clinical outcome risk [odds ratio (OR), 5.9; 95% confidence interval (CI), 2.8-12.0; P < 0.001]. Moreover, hyponatraemia impacts on composite endpoints were driven by both parameters; it was independently associated with mortality (OR, 3.1; 95% CI, 1.4-6.8; P = 0.003) and rehospitalization (OR, 5.3; 95% CI, 2.4-11.7; P < 0.001). This result remained consistent in most subgroups. CONCLUSIONS On-admission hyponatraemia is a predictor for 6 month mortality and rehospitalization. Further work is needed to determine if correction of hyponatraemia translates into clinical benefit.
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Affiliation(s)
- Yuke Sarastri
- Faculty of MedicineUniversitas Sumatera UtaraMedanIndonesia
- Department of Cardiology and Vascular MedicineRSUP Haji Adam Malik MedanMedanIndonesia
| | - Juang Idaman Zebua
- Department of Cardiology and Vascular MedicineRSUP Haji Adam Malik MedanMedanIndonesia
| | - Puja Nastia Lubis
- Department of Cardiology and Vascular MedicineRSUP Haji Adam Malik MedanMedanIndonesia
| | - Fathi Zahra
- Faculty of MedicineUniversitas TrisaktiWest JakartaIndonesia
| | - Anggia Chairuddin Lubis
- Faculty of MedicineUniversitas Sumatera UtaraMedanIndonesia
- Department of Cardiology and Vascular MedicineRSUP Haji Adam Malik MedanMedanIndonesia
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2
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Dhont S, Martens P, Meekers E, Dauw J, Verbrugge FH, Nijst P, Ter Maaten JM, Damman K, Mebazaa A, Filippatos G, Ruschitzka F, Tang WHW, Dupont M, Mullens W. Sodium and potassium changes during decongestion with acetazolamide - A pre-specified analysis from the ADVOR trial. Eur J Heart Fail 2023; 25:1310-1319. [PMID: 37062871 DOI: 10.1002/ejhf.2863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/28/2023] [Accepted: 04/08/2023] [Indexed: 04/18/2023] Open
Abstract
AIMS Acetazolamide, an inhibitor of proximal tubular sodium reabsorption, leads to more effective decongestion in acute heart failure (AHF). It is unknown whether acetazolamide alters serum sodium and potassium levels on top of loop diuretics and if baseline values modify the treatment effect of acetazolamide. METHODS AND RESULTS This is a pre-specified sub-analysis of the ADVOR trial that randomized 519 patients with AHF and volume overload in a 1:1 ratio to intravenous acetazolamide or matching placebo on top of standardized intravenous loop diuretics. Mean potassium and sodium levels at randomization were 4.2 ± 0.6 and 139 ± 4 mmol/L in the acetazolamide arm versus 4.2 ± 0.6 and 140 ± 4 mmol/L in the placebo arm. Hypokalaemia (<3.5 mmol/L) on admission was present in 44 (9%) patients and hyponatraemia (≤135 mmol/L) in 82 (16%) patients. After 3 days of treatment, 44 (17%) patients in the acetazolamide arm and 35 (14%) patients in the placebo arm developed hyponatraemia (p = 0.255). Patients randomized to acetazolamide demonstrated a slight decrease in mean potassium levels during decongestion, which was non-significant over time (p = 0.053) and had no significant impact on hypokalaemia incidence (p = 0.061). Severe hypokalaemia (<3.0 mmol/L) occurred in only 7 (1%) patients, similarly distributed between the two treatment arms (p = 0.676). Randomization towards acetazolamide improved decongestive response irrespective of baseline serum sodium and potassium levels. CONCLUSIONS Acetazolamide on top of standardized loop diuretic therapy does not lead to clinically important hypokalaemia or hyponatraemia and improves decongestion over the entire range of baseline serum potassium and sodium levels.
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Affiliation(s)
- Sebastiaan Dhont
- Department of Cardiology, Ziekenhuis Oost-Limburg A.V, Genk, Belgium
- Hasselt University, Diepenbeek/Hasselt, Belgium
| | - Pieter Martens
- Department of Cardiology, Ziekenhuis Oost-Limburg A.V, Genk, Belgium
- Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Evelyne Meekers
- Department of Cardiology, Ziekenhuis Oost-Limburg A.V, Genk, Belgium
- Hasselt University, Diepenbeek/Hasselt, Belgium
| | - Jeroen Dauw
- Hasselt University, Diepenbeek/Hasselt, Belgium
- Department of Cardiology, AZ Sint-Lucas, Ghent, Belgium
| | - Frederik H Verbrugge
- Centre for Cardiovascular Diseases, University Hospital Brussels, Jette, Belgium
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Jette, Belgium
| | - Petra Nijst
- Department of Cardiology, Ziekenhuis Oost-Limburg A.V, Genk, Belgium
| | - Jozine M Ter Maaten
- Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Kevin Damman
- Department of Cardiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | | | | | - Frank Ruschitzka
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - W H Wilson Tang
- Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Matthias Dupont
- Department of Cardiology, Ziekenhuis Oost-Limburg A.V, Genk, Belgium
| | - Wilfried Mullens
- Department of Cardiology, Ziekenhuis Oost-Limburg A.V, Genk, Belgium
- Hasselt University, Diepenbeek/Hasselt, Belgium
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3
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Brandenburg V, Bauersachs J, Böhm M, Fliser D, Frantz S, Frey N, Hasenfuß G, Kielstein JT. [Symptom control in heart failure patients - how to handle GFR decrease and hyperkalaemia]. Dtsch Med Wochenschr 2021; 146:e47-e55. [PMID: 33482670 PMCID: PMC7972821 DOI: 10.1055/a-1307-8652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Bei Patienten mit Herzinsuffizienz und reduzierter Ejektionsfraktion wird durch eine optimierte medikamentöse Therapie sowohl die Symptomkontrolle verbessert als auch die Mortalität gesenkt. Eckpfeiler der Herzinsuffizienztherapie sind dabei Medikamente mit Einfluss auf das Renin-Angiotensin-Aldosteron-System, sogenannte RAAS-Inhibitoren. Dieser Artikel stellt einen kardiologisch-nephrologischen Konsens zur praxisorientierten Hilfestellung bei abnehmender glomerulärer Filtrationsrate oder Anstieg des Serum-Kaliumspiegels vor. Dies sind die 2 häufigsten Gründe für eine Dosisreduktion oder das Absetzen von prognoseverbessernden Medikamenten bei Herzinsuffizienzpatienten.
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Affiliation(s)
- Vincent Brandenburg
- Klinik für Kardiologie, Nephrologie und Internistische Intensivmedizin, Rhein-Maas-Klinikum, Würselen
| | - Johann Bauersachs
- Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover
| | - Michael Böhm
- Innere Medizin III - Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar
| | - Danilo Fliser
- Innere Medizin IV - Nieren- und Hochdruckkrankheiten, Universitätsklinikum des Saarlandes, Homburg/Saar
| | - Stefan Frantz
- Medizinische Klinik und Poliklinik I (Kardiologie, Endokrinologie, Nephrologie, Pneumologie, Intensiv- und Notfallmedizin) Universitätsklinikum Würzburg
| | - Norbert Frey
- Klinik für Innere Medizin III (Schwerpunkt Kardiologie, Angiologie und Intensivmedizin), Universitätsklinikum Schleswig-Holstein, Kiel
| | - Gerd Hasenfuß
- Herzzentrum, Abt. Kardiologie und Pneumologie, Universitätsmedizin Göttingen
| | - Jan T Kielstein
- Klinik für Nephrologie, Blutreinigung und Rheumatologie, Klinikum Braunschweig
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4
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Caravaca Perez P, González-Juanatey JR, Nuche J, Morán Fernández L, Lora Pablos D, Alvarez-García J, Bascompte Claret R, Martínez Selles M, Vázquez García R, Martínez Dolz L, Cobo-Marcos M, Pascual Figal D, Crespo-Leiro MG, Nuñez Villota J, Cinca Cuscullola J, Delgado JF. Serum potassium dynamics during acute heart failure hospitalization. Clin Res Cardiol 2020; 111:368-379. [DOI: 10.1007/s00392-020-01753-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 09/30/2020] [Indexed: 12/27/2022]
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O’Sullivan KF, Kashef MA, Knee AB, Roseman AS, Pekow PS, Stefan MS, Shieh MS, Pack QR, Lindenauer PK, Lagu T. Examining the "Repletion Reflex": The Association between Serum Potassium and Outcomes in Hospitalized Patients with Heart Failure. J Hosp Med 2019; 14:729-736. [PMID: 31339844 PMCID: PMC6897537 DOI: 10.12788/jhm.3270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND In patients hospitalized with heart failure (HF) exacerbations, physicians routinely supplement potassium to maintain levels ≥4.0 mEq/L. The evidence basis for this practice is relatively weak. We aimed to evaluate the association between serum potassium levels and outcomes in patients hospitalized with HF. METHODS We identified patients admitted with acute HF exacerbations to hospitals that contributed to an electronic health record-derived dataset. In a subset of patients with normal admission serum potassium (3.5-5.0 mEq/L), we averaged serum potassium values during a 72-hour exposure window and categorized as follows: <4.0 mEq/L (low normal), 4.0-4.5 mEq/L (medium normal), and >4.5 mEq/L (high normal). We created multivariable models examining associations between these categories and outcomes. RESULTS We included 4,995 patients: 2,080 (41.6%), 2,326 (46.6%), and 589 (11.8%) in the <4.0, 4.0-4.5, and >4.5 mEq/L cohorts, respectively. After adjustment for demographics, comorbidities, and presenting severity, we observed no difference in outcomes between the low and medium normal groups. Compared to patients with levels <4.0 mEq/L, patients with a potassium level of >4.5 mEq/L had a longer length of stay (median of 0.6 days; 95% CI = 0.1 to 1.0) but did not have statistically significant increases in mortality (OR [odds ratio] = 1.51; 95% CI = 0.97 to 2.36) or transfers to the intensive care unit (OR = 1.78; 95% CI = 0.98 to 3.26). CONCLUSIONS Inpatients with heart failure who had mean serum potassium levels of <4.0 showed similar outcomes to those with mean serum potassium values of 4.0-4.5. Compared with mean serum potassium level of <4.0, mean serum levels of >4.5 may be associated with increased risk of poor outcomes.
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Affiliation(s)
- Kevin F O’Sullivan
- Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School-Baystate, Springfield, Massachusetts
- University of Massachusetts Medical School, Worcester, Massachusetts
| | - Mohammad Amin Kashef
- Department of Medicine, University of Massachusetts Medical School-Bay-state, Springfield, Massachusetts
- Division of Cardiology, Baystate Medical Center, Springfield, Massachusetts
- Epidemiology and Biostatistics Research Core, Office of Research, University of Massachusetts Medical School-Baystate, Springfield, Massachusetts
| | - Alexander B Knee
- Department of Medicine, University of Massachusetts Medical School-Bay-state, Springfield, Massachusetts
- Epidemiology and Biostatistics Research Core, Office of Research, University of Massachusetts Medical School-Baystate, Springfield, Massachusetts
| | - Alexander S Roseman
- Department of Medicine, University of Massachusetts Medical School-Bay-state, Springfield, Massachusetts
| | - Penelope S Pekow
- Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School-Baystate, Springfield, Massachusetts
- University of Massachusetts-Amherst, Amherst, Massachusetts
| | - Mihaela S Stefan
- Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School-Baystate, Springfield, Massachusetts
- Department of Medicine, University of Massachusetts Medical School-Bay-state, Springfield, Massachusetts
| | - Meng-Shiou Shieh
- Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School-Baystate, Springfield, Massachusetts
| | - Quinn R Pack
- Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School-Baystate, Springfield, Massachusetts
- Division of Cardiology, Baystate Medical Center, Springfield, Massachusetts
| | - Peter K Lindenauer
- Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School-Baystate, Springfield, Massachusetts
- Department of Medicine, University of Massachusetts Medical School-Bay-state, Springfield, Massachusetts
| | - Tara Lagu
- Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School-Baystate, Springfield, Massachusetts
- Department of Medicine, University of Massachusetts Medical School-Bay-state, Springfield, Massachusetts
- Corresponding Author: Tara Lagu, MD, MPH; E-mail: ; Telephone: 413-505-9173
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6
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Tamaki S, Yamada T, Morita T, Furukawa Y, Iwasaki Y, Kawasaki M, Kikuchi A, Kawai T, Seo M, Abe M, Nakamura J, Yamamoto K, Kayama K, Kawahira M, Tanabe K, Ueda K, Kimura T, Sakamoto D, Fukunami M. Prognostic Value of Calculated Plasma Volume Status in Patients Admitted for Acute Decompensated Heart Failure - A Prospective Comparative Study With Other Indices of Plasma Volume. Circ Rep 2019; 1:361-371. [PMID: 33693164 PMCID: PMC7892481 DOI: 10.1253/circrep.cr-19-0039] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background: Congestion is one of the main predictors of poor outcome in patients with heart failure (HF); thus, a simple tool to evaluate plasma volume (PV), which can be used for risk stratification of HF patients, is necessary. We sought to compare the prognostic values of commonly used formulas for the estimation of PV and relative PV status (PVS) in patients admitted with acute decompensated HF (ADHF). Methods and Results: We analyzed 384 consecutive ADHF patients who survived to discharge. The PV was calculated by 3 commonly used formulas (Strauss, Kaplan, and Hakim), and the relative PVS was calculated using the Hakim formula at both admission and discharge. The primary endpoint was a composite of all-cause mortality and hospitalization for worsening HF. The secondary endpoints were pump failure death (PFD) and sudden cardiac death (SCD). During a median follow-up of 743 days, 175 patients reached the primary endpoint, 28 patients had PFD, and 20 patients had SCD. Multivariate Cox analysis revealed that among the PV indices, only the PVS values at admission and discharge were independent predictors of the primary endpoint. In addition, the PVS values at admission and discharge were independent predictors of PFD and SCD in the multivariate analysis. Conclusions: Among the indices of PV, the calculated PVS may be the most useful for predicting prognosis in ADHF patients.
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Affiliation(s)
- Shunsuke Tamaki
- Division of Cardiology, Osaka General Medical Center Osaka Japan
| | - Takahisa Yamada
- Division of Cardiology, Osaka General Medical Center Osaka Japan
| | - Takashi Morita
- Division of Cardiology, Osaka General Medical Center Osaka Japan
| | - Yoshio Furukawa
- Division of Cardiology, Osaka General Medical Center Osaka Japan
| | - Yusuke Iwasaki
- Division of Cardiology, Osaka General Medical Center Osaka Japan
| | - Masato Kawasaki
- Division of Cardiology, Osaka General Medical Center Osaka Japan
| | - Atsushi Kikuchi
- Division of Cardiology, Osaka General Medical Center Osaka Japan
| | - Tsutomu Kawai
- Division of Cardiology, Osaka General Medical Center Osaka Japan
| | - Masahiro Seo
- Division of Cardiology, Osaka General Medical Center Osaka Japan
| | - Makoto Abe
- Division of Cardiology, Osaka General Medical Center Osaka Japan
| | - Jun Nakamura
- Division of Cardiology, Osaka General Medical Center Osaka Japan
| | - Kyoko Yamamoto
- Division of Cardiology, Osaka General Medical Center Osaka Japan
| | - Kiyomi Kayama
- Division of Cardiology, Osaka General Medical Center Osaka Japan
| | | | - Kazuya Tanabe
- Division of Cardiology, Osaka General Medical Center Osaka Japan
| | - Kunpei Ueda
- Division of Cardiology, Osaka General Medical Center Osaka Japan
| | - Takanari Kimura
- Division of Cardiology, Osaka General Medical Center Osaka Japan
| | - Daisuke Sakamoto
- Division of Cardiology, Osaka General Medical Center Osaka Japan
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Basnet S, Dhital R, Tharu B, Ghimire S, Poudel DR, Donato A. Influence of abnormal potassium levels on mortality among hospitalized heart failure patients in the US: data from National Inpatient Sample. J Community Hosp Intern Med Perspect 2019; 9:103-107. [PMID: 31044040 PMCID: PMC6484484 DOI: 10.1080/20009666.2019.1593778] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 03/07/2019] [Indexed: 12/28/2022] Open
Abstract
Background: Abnormalities in serum potassium levels have been associated with variable mortality risk among hospitalized patients with heart failure (HF). We aim to use a large database study to further characterize risk of mortality, demographic factors, and associated comorbidities among heart failure inpatients. Methods: Our sample population was from the US National Inpatient Sample database from the year 2009–2011. The inclusion criteria used to identify patients was those with a diagnosis of heart failure as per ICD-9 classification. Other demographic factors considered in data collection included income, and cardiac risk factors. Taking these factors into consideration, a univariate association of potassium level and mortality was performed, as well as multivariable logistic regression controlling for demographic factors and associated conditions. Results: Of the 2,660,609 patients who were discharged with a diagnosis of heart failure during this time period, patients with hypokalemia during hospitalization had increased mortality risk (OR: 1.96, 95% CI: 1.91–2.01) when compared with those with hyperkalemia who had decreased inpatient mortality risk OR: 0.94,95% CI: 0.91–0.96) versus those not coded for potassium abnormalities. This finding was significant even regardless of the etiology of the hypokalemia while the hyperkalemic patients were noted to have no difference or a decreased risk in all subtypes and groups. Conclusion: Unlike heart failure patients with hyperkalemia, those with hypokalemia are at an increased inpatient mortality risk. Whether our mortality findings translate to longer-term outpatient settings where significantly less monitoring is possible is a matter for further study.
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Affiliation(s)
- Sijan Basnet
- Department of Internal Medicine, Reading Hospital and Medical Center, West Reading, PA, USA
| | - Rashmi Dhital
- Department of Internal Medicine, Reading Hospital and Medical Center, West Reading, PA, USA
| | - Biswaraj Tharu
- Department of Internal Medicine, Trumbull Regional Medical Center, Warren, OH, USA
| | - Sushil Ghimire
- Department of Internal Medicine, Reading Hospital and Medical Center, West Reading, PA, USA
| | - Dilli Ram Poudel
- Department of Internal Medicine, Reading Hospital and Medical Center, West Reading, PA, USA
| | - Anthony Donato
- Department of Internal Medicine, Reading Hospital and Medical Center, West Reading, PA, USA
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8
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Formiga F, Chivite D, Corbella X, Conde-Martel A, Arévalo-Lorido JC, Trullàs JC, Silvestre JP, García SC, Manzano L, Montero-Pérez-Barquero M. Influence of potassium levels on one-year outcomes in elderly patients with acute heart failure. Eur J Intern Med 2019; 60:24-30. [PMID: 30722845 DOI: 10.1016/j.ejim.2018.10.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 10/15/2018] [Accepted: 10/18/2018] [Indexed: 01/21/2023]
Abstract
BACKGROUND Abnormal serum potassium levels (K+) in patients with heart failure (HF) relate to worse prognosis. We evaluated whether admission K+ levels predict 1-year outcomes in elderly patients admitted for acute HF. METHODS We evaluated 2865 patients aged >74 years from the RICA Spanish Heart Failure Registry, classified according to admission serum K+ levels: hyperkalemia (>5.5 mmol/L), normokalemia (3.5-5.5 mmol/L) and hypokalemia (<3.5 mmol/L). We explored whether K+ levels were significantly associated with one-year all-cause mortality or hospital readmission and their combination. RESULTS Mean admission K+ value was 4.3 ± 0.6 mmol/L; 97 patients (3.38%) presented with hyperkalemia and 174 (6.06%) with hypokalemia. Overall, 43% of the patients died or were readmitted for HF during the follow-up period; the risk was higher for those with hyperkalemia (59% vs 41% in hypokalemic patients). The HR for one-year mortality was 1.43 (p = .073) and 1.67 for readmissions (p = .007) when K+ was >5.5 mmol/L and 1.08 (p = .618) and 0.90 (p = .533) respectively for K+ < 3.5 mmol/L. The HR for the combined outcome was 1.59 (1.19-2.13); p = .002 in hyperkalemic patients and 0.96 (0.75-1.23); p = .751in hypokalemic patients. Multivariate analysis showed a significant association of admission K+ values >5.5 mmol/L with the combined outcome of mortality and readmission (HR 1.15 [95% CI 1.04-1.27], p = .008). CONCLUSION In patients hospitalized for decompensated HF, admission hyperkalemia predicts a higher mid-term risk for HF readmission and mortality, probably related to the significant higher risk of readmission.
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Affiliation(s)
- Francesc Formiga
- Geriatric Unit, Internal Medicine Department, Hospital Universitari de Bellvitge-IDIBELL, L' Hospitalet de Llobregat, Barcelona, Spain.
| | - David Chivite
- Geriatric Unit, Internal Medicine Department, Hospital Universitari de Bellvitge-IDIBELL, L' Hospitalet de Llobregat, Barcelona, Spain
| | - Xavier Corbella
- Geriatric Unit, Internal Medicine Department, Hospital Universitari de Bellvitge-IDIBELL, L' Hospitalet de Llobregat, Barcelona, Spain; Hestia Chair, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Alicia Conde-Martel
- Internal Medicine Department, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Las Palmas, Spain
| | | | - Joan Carles Trullàs
- Intenal Medicine Service, Hospital d'Olot i comarcal de la Garrtoxa, Olot, Girona, Spain and Medical Science Department, Universitat de Girona, Girona, Spain
| | - José Pérez Silvestre
- Internal Medicine Department, Hospital General Universitario de Valencia, Valencia, Spain
| | - Sara Carrascosa García
- Internal Medicine Department, Hospital General Universitario de Valencia, Valencia, Spain
| | - Luis Manzano
- Internal Medicine Department, Hospital Universitario Ramón y Cajal, Universidad de Alcalá (IRYCIS), Madrid, Spain
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9
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Butler J, Vijayakumar S, Pitt B. Need to revisit heart failure treatment guidelines for hyperkalaemia management during the use of mineralocorticoid receptor antagonists. Eur J Heart Fail 2018; 20:1247-1251. [PMID: 29882618 PMCID: PMC6125193 DOI: 10.1002/ejhf.1217] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 04/16/2018] [Accepted: 04/22/2018] [Indexed: 11/05/2022] Open
Affiliation(s)
- Javed Butler
- Division of Cardiology, Department of Medicine, Stony Brook University, Stony Brook, NY
| | - Shilpa Vijayakumar
- Division of Cardiology, Department of Medicine, Stony Brook University, Stony Brook, NY
| | - Bertram Pitt
- Division of Cardiology, Department of Medicine, University of Michigan, Ann Arbor, MI
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10
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Mohammadifard N, Gotay C, Humphries KH, Ignaszewski A, Esmaillzadeh A, Sarrafzadegan N. Electrolyte minerals intake and cardiovascular health. Crit Rev Food Sci Nutr 2018. [DOI: 10.1080/10408398.2018.1453474] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Noushin Mohammadifard
- Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
- Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Carolyn Gotay
- Centre of Excellence in Cancer Prevention, Faculty of Medicine, School of Population and Public Health, The University of British Columbia, Vancouver, Canada
| | - Karin H. Humphries
- Division of Cardiology, The University of British Columbia, Vancouver, Canada
| | - Andrew Ignaszewski
- Division of Cardiology, The University of British Columbia, Vancouver, Canada
| | - Ahmad Esmaillzadeh
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Nizal Sarrafzadegan
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
- School of Population and Public Health, Faculty of Medicine, The University of British Columbia, Canada
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11
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Kok W, Salah K, Stienen S. Serum Potassium Levels During Admissions for Acute Decompensated Heart Failure: Identifying Possible Threats to Outcome. Am J Cardiol 2018; 121:141. [PMID: 29126581 DOI: 10.1016/j.amjcard.2017.09.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 09/12/2017] [Indexed: 10/18/2022]
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12
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Affiliation(s)
- David H. Ellison
- Oregon Clinical & Translational Research Institute, Oregon Health & Science University and VA Portland Health Care System, Portland, OR
| | - G. Michael Felker
- Duke University School of Medicine and Duke Clinical Research Institute, Durham, NC
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13
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Shiyovich A, Gilutz H, Plakht Y. Potassium Fluctuations Are Associated With Inhospital Mortality From Acute Myocardial Infarction. Soroka Acute Myocardial Infarction II (SAMI-II) Project. Angiology 2017; 69:709-717. [DOI: 10.1177/0003319717740004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Potassium levels (K, mEq/L) fluctuate in patients with acute myocardial infarction (AMI). Potassium was reported to be associated with prognosis in patients with AMI; however, studies evaluating the prognostic value of K fluctuations in this setting are scarce. We retrospectively analyzed patients with AMI hospitalized in a tertiary medical center, through 2002 to 2012. Patients on chronic dialysis or mechanical ventilation were excluded. Based on all K values during hospitalization, minimal, maximal, and fluctuation (gap between 2 consecutive K) were recorded. Primary outcome was inhospital all-cause mortality. Overall, 10 032 patients were studied (age 68.1 ± 14.3 years, 65.4% males, 44.2% ST-segment elevation MI), of which 507 (3.7%) died in hospital. Potassium decreased during the first 2 to 3 days ( P for trend <.001), followed by stabilization ( P for trend = .807). Potassium in the extreme categories (<3.8 and ≥4.7) and absolute fluctuations >0.1 mEq/L were more common among nonsurvivors than survivors ( P < .001 each). In a multivariate analysis, combinations of minimal K <3.8 with maximal K ≥4.7 (odds ratio [OR] = 18.1), K ≥4.4 with fluctuation ≥0.1 (OR = 1.74), or <−0.1 (OR = 2.6) and minimal K after the first 2 admission days (OR = 2.07) were associated with increased risk of mortality ( P < .001 each). Potassium fluctuations, peak and nadir K, and its timing independently predict inhospital mortality in patients with AMI.
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Affiliation(s)
- Arthur Shiyovich
- Department of Cardiology, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Harel Gilutz
- Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ygal Plakht
- Soroka University Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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14
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Núñez J, Bayés-Genís A, Zannad F, Rossignol P, Núñez E, Bodí V, Miñana G, Santas E, Chorro FJ, Mollar A, Carratalá A, Navarro J, Górriz JL, Lupón J, Husser O, Metra M, Sanchis J. Long-Term Potassium Monitoring and Dynamics in Heart Failure and Risk of Mortality. Circulation 2017; 137:1320-1330. [PMID: 29025765 DOI: 10.1161/circulationaha.117.030576] [Citation(s) in RCA: 111] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 09/27/2017] [Indexed: 01/14/2023]
Abstract
BACKGROUND The prognostic value of long-term potassium monitoring and dynamics in heart failure has not been characterized completely. We sought to determine the association between serum potassium values collected at follow-up with all-cause mortality in a prospective and consecutive cohort of patients discharged from a previous acute heart failure admission. METHODS Serum potassium was measured at every physician-patient encounter, including hospital admissions and ambulatory settings. The multivariable-adjusted association of serum potassium with mortality was assessed by using comprehensive state-of-the-art regression methods that can accommodate time-dependent exposure modeling. RESULTS The study sample included 2164 patients with a total of 16 116 potassium observations. Mean potassium at discharge was 4.3±0.48 mEq/L. Hypokalemia (<3.5 mEq/L), normokalemia (3.5-5.0 mEq/L), and hyperkalemia (>5 mEq/L) were observed at the index admission in 77 (3.6%), 1965 (90.8%), and 122 (5.6%) patients, respectively. At a median follow-up of 2.8 years (range, 0.03-12.8 years), 1090 patients died (50.4%). On a continuous scale, the multivariable-adjusted association of potassium values and mortality revealed a nonlinear association (U-shaped) with higher risk at both ends of its distribution (omnibus P=0.001). Likewise, the adjusted hazard ratios for hypokalemia and hyperkalemia, normokalemia as reference, were 2.35 (95% confidence interval, 1.40-3.93; P=0.001) and 1.55 (95% confidence interval, 1.11-2.16; P=0.011), respectively (omnibus P=0.0003). Furthermore, dynamic changes in potassium were independently associated with substantial differences in mortality risk. Potassium normalization was independently associated with lower mortality risk (P=0.001). CONCLUSIONS Either modeled continuously or categorically, serum potassium levels during long-term monitoring were independently associated with mortality in patients with heart failure. Likewise, persistence of abnormal potassium levels was linked to a higher risk of death in comparison with patients who maintained or returned to normal values.
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Affiliation(s)
- Julio Núñez
- Cardiology Department, Hosfpital Clínico Universitario de Valencia, INCLIVA. Departamento de Medicina, Universitat de València, Spain (J.N., E.N., V.B., G.M., E.S., F.J.C., A.M., J.S.) .,CIBER in Cardiovascular Diseases (CIBERCV), Madrid, Spain (J.N., A.B.-G., G.M., A.M., J.L., J.S.)
| | - Antoni Bayés-Genís
- CIBER in Cardiovascular Diseases (CIBERCV), Madrid, Spain (J.N., A.B.-G., G.M., A.M., J.L., J.S.).,Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain, and Department of Medicine, Autonomous University of Barcelona, Spain (A.B.-G., J.L.)
| | - Faiez Zannad
- Inserm, Centre d'Investigation Clinique Plurithématique 1433, Inserm U1116, Université de Lorraine, CHRU de Nancy, F-CRIN INI-CRCT, France (F.Z., P.R.)
| | - Patrick Rossignol
- Inserm, Centre d'Investigation Clinique Plurithématique 1433, Inserm U1116, Université de Lorraine, CHRU de Nancy, F-CRIN INI-CRCT, France (F.Z., P.R.)
| | - Eduardo Núñez
- Cardiology Department, Hosfpital Clínico Universitario de Valencia, INCLIVA. Departamento de Medicina, Universitat de València, Spain (J.N., E.N., V.B., G.M., E.S., F.J.C., A.M., J.S.)
| | - Vicent Bodí
- Cardiology Department, Hosfpital Clínico Universitario de Valencia, INCLIVA. Departamento de Medicina, Universitat de València, Spain (J.N., E.N., V.B., G.M., E.S., F.J.C., A.M., J.S.)
| | - Gema Miñana
- Cardiology Department, Hosfpital Clínico Universitario de Valencia, INCLIVA. Departamento de Medicina, Universitat de València, Spain (J.N., E.N., V.B., G.M., E.S., F.J.C., A.M., J.S.).,CIBER in Cardiovascular Diseases (CIBERCV), Madrid, Spain (J.N., A.B.-G., G.M., A.M., J.L., J.S.)
| | - Enrique Santas
- Cardiology Department, Hosfpital Clínico Universitario de Valencia, INCLIVA. Departamento de Medicina, Universitat de València, Spain (J.N., E.N., V.B., G.M., E.S., F.J.C., A.M., J.S.)
| | - Francisco J Chorro
- Cardiology Department, Hosfpital Clínico Universitario de Valencia, INCLIVA. Departamento de Medicina, Universitat de València, Spain (J.N., E.N., V.B., G.M., E.S., F.J.C., A.M., J.S.)
| | - Anna Mollar
- Cardiology Department, Hosfpital Clínico Universitario de Valencia, INCLIVA. Departamento de Medicina, Universitat de València, Spain (J.N., E.N., V.B., G.M., E.S., F.J.C., A.M., J.S.).,CIBER in Cardiovascular Diseases (CIBERCV), Madrid, Spain (J.N., A.B.-G., G.M., A.M., J.L., J.S.)
| | - Arturo Carratalá
- Biochemistry Department, Hospital Clínico Universitario de Valencia, INCLIVA, Spain (A.C.)
| | - Jorge Navarro
- Hospital Clínico Universitario, Universitat de València, INCLIVA, Spain. CIBERESP (J.N.)
| | - Jose Luis Górriz
- Nephrology Department, Hospital Clínico Universitario, INCLIVA, Department of Medicine, Universitat de València, Spain (J.L.G.)
| | - Josep Lupón
- CIBER in Cardiovascular Diseases (CIBERCV), Madrid, Spain (J.N., A.B.-G., G.M., A.M., J.L., J.S.).,Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain, and Department of Medicine, Autonomous University of Barcelona, Spain (A.B.-G., J.L.)
| | - Oliver Husser
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technical University Munich, Germany (O.H.)
| | - Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Italy (M.M.)
| | - Juan Sanchis
- Cardiology Department, Hosfpital Clínico Universitario de Valencia, INCLIVA. Departamento de Medicina, Universitat de València, Spain (J.N., E.N., V.B., G.M., E.S., F.J.C., A.M., J.S.).,CIBER in Cardiovascular Diseases (CIBERCV), Madrid, Spain (J.N., A.B.-G., G.M., A.M., J.L., J.S.)
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Ezekowitz JA, O'Meara E, McDonald MA, Abrams H, Chan M, Ducharme A, Giannetti N, Grzeslo A, Hamilton PG, Heckman GA, Howlett JG, Koshman SL, Lepage S, McKelvie RS, Moe GW, Rajda M, Swiggum E, Virani SA, Zieroth S, Al-Hesayen A, Cohen-Solal A, D'Astous M, De S, Estrella-Holder E, Fremes S, Green L, Haddad H, Harkness K, Hernandez AF, Kouz S, LeBlanc MH, Masoudi FA, Ross HJ, Roussin A, Sussex B. 2017 Comprehensive Update of the Canadian Cardiovascular Society Guidelines for the Management of Heart Failure. Can J Cardiol 2017; 33:1342-1433. [PMID: 29111106 DOI: 10.1016/j.cjca.2017.08.022] [Citation(s) in RCA: 433] [Impact Index Per Article: 61.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 08/28/2017] [Accepted: 08/28/2017] [Indexed: 02/06/2023] Open
Abstract
Since the inception of the Canadian Cardiovascular Society heart failure (HF) guidelines in 2006, much has changed in the care for patients with HF. Over the past decade, the HF Guidelines Committee has published regular updates. However, because of the major changes that have occurred, the Guidelines Committee believes that a comprehensive reassessment of the HF management recommendations is presently needed, with a view to producing a full and complete set of updated guidelines. The primary and secondary Canadian Cardiovascular Society HF panel members as well as external experts have reviewed clinically relevant literature to provide guidance for the practicing clinician. The 2017 HF guidelines provide updated guidance on the diagnosis and management (self-care, pharmacologic, nonpharmacologic, device, and referral) that should aid in day-to-day decisions for caring for patients with HF. Among specific issues covered are risk scores, the differences in management for HF with preserved vs reduced ejection fraction, exercise and rehabilitation, implantable devices, revascularization, right ventricular dysfunction, anemia, and iron deficiency, cardiorenal syndrome, sleep apnea, cardiomyopathies, HF in pregnancy, cardio-oncology, and myocarditis. We devoted attention to strategies and treatments to prevent HF, to the organization of HF care, comorbidity management, as well as practical issues around the timing of referral and follow-up care. Recognition and treatment of advanced HF is another important aspect of this update, including how to select advanced therapies as well as end of life considerations. Finally, we acknowledge the remaining gaps in evidence that need to be filled by future research.
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Affiliation(s)
| | - Eileen O'Meara
- Institut de Cardiologie de Montréal, Université de Montréal, Montréal, Québec, Canada
| | | | | | - Michael Chan
- Edmonton Cardiology Consultants, Edmonton, Alberta, Canada
| | - Anique Ducharme
- Institut de Cardiologie de Montréal, Université de Montréal, Montréal, Québec, Canada
| | | | - Adam Grzeslo
- Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | | | | | | | | | - Serge Lepage
- Université de Sherbrooke, Sherbrooke, Québec, Canada
| | | | | | - Miroslaw Rajda
- QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
| | | | - Sean A Virani
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | - Sabe De
- London Health Sciences, Western University, London, Ontario, Canada
| | | | - Stephen Fremes
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Lee Green
- University of Alberta, Edmonton, Alberta, Canada
| | - Haissam Haddad
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Karen Harkness
- Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | | | - Simon Kouz
- Centre Hospitalier Régional de Lanaudière, Joliette, Québec, Canada
| | | | | | | | - Andre Roussin
- Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Bruce Sussex
- Memorial University, St John's, Newfoundland, Canada
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