Hyperkalemia Linked to CV Events in Patients with Heart Failure

In a large, real-world population study of patients with heart failure (HF), hyperkalemia was common and linked to future major adverse cardiovascular events (MACE).

Hyperkalemia (HK) occurs when there are high levels of potassium in the blood. This disorder is a potential complication from the use of renin-angiotensin-aldosterone system inhibitors (RAASi), a common treatment for HF. In this analysis, researchers assessed the impact of HK and RAASi use on clinical outcomes in patients experiencing HF.

The study enrolled 48,333 adult patients with an HF diagnosis and at least two separate, non-urgent or emergency care encounters between 2003 and 2018. Participants were stratified according to the presence/absence of HK (serum potassium >5.0 mmol/L) and baseline left ventricular ejection fraction (LVEF). In total, 31,619 patients had HK and 20,634 did not. The HK cohort had significantly higher rates of baseline cardiovascular risk factors, prior diagnoses, and greater RAASi use in both baseline and follow-up periods, compared with patients without HK. Primary outcomes included RAASi use and rate of MACE at 3 years.

Between baseline and analysis, RAASi use decreased by 5% for the HK group but increased by 20% for the non-HK group. Across all patient stratification, MACE and death were consistently highest for those with HK without RAASi treatment (63% and 62%, respectively) and lowest in non-HK patients receiving RAASi (25% and 21%, respectively). These trends were consistent regardless of baseline LVEF.

“In this large, real-world HF population, HK was common and linked to baseline clinical risk factors, declining use of RAASi treatment, and an increase in future MACE, regardless of baseline LVEF. Both HK and reduced RAASi use were independent predictors of future MACE,” the researchers concluded.

This study was published in ESC Heart Failure.