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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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