Matthieu Legrand1,2,3,4, Pierre-Olivier Ludes5,6, Ziad Massy7,8, Patrick Rossignol9, Jiri Parenica10,11, Jin-Joo Park12, Shiro Ishihara13, Khalid F AlHabib14, Aldo Maggioni15, Òscar Miró16, Naoki Sato13, Alain Cohen-Solal17, Enrique Fairman18, Johan Lassus19, Veli-Pekka Harjola19, Christian Mueller20, Franck W Peacock21, Dong-Ju Choi12, Patrick Plaisance22, Jindřich Spinar10,11, Mikhail Kosiborod23, Alexandre Mebazaa5,6,24,25, Etienne Gayat5,6,24,25. 1. Department of Anesthesiology and Critical Care and Burn Unit, St-Louis Hospital, Assistance Publique- Hôpitaux de Paris,, Paris, France. matthieu.legrand@aphp.fr. 2. AP-HP, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal, Paris, France. matthieu.legrand@aphp.fr. 3. Université Paris Diderot, Sorbonne Paris Cité, Paris, France. matthieu.legrand@aphp.fr. 4. UMR 942, INSERM, Paris, France. matthieu.legrand@aphp.fr. 5. Department of Anesthesiology and Critical Care and Burn Unit, St-Louis Hospital, Assistance Publique- Hôpitaux de Paris,, Paris, France. 6. AP-HP, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal, Paris, France. 7. Division of Nephrology, Ambroise Paré university hospital, APHP, University of Paris Ouest-Versailles-St-Quentin-en-Yvelines (UVSQ), Boulogne-Billancourt, Paris, France. 8. INSERM U1018 Team5, Research Centre in Epidemiology and Population Health (CESP), Univ. Paris-Sud, UVSQ, Université Paris-Saclay, Villejuif, France. 9. INSERM, Centre d'Investigations Cliniques Plurithématique 1433, INSERM U1116, Université de Lorraine, CHRU de Nancy, F-CRIN INI-CRCT, Nancy, France. 10. Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic. 11. Faculty of Medicine, Masaryk University, Brno, Czech Republic. 12. Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Seoul National University Bundang Hospital, Seoul, South Korea. 13. Nippon Medical School Musashi-Kosugi Hospital, Kanagawa, Japan. 14. Department of Cardiac Sciences, College of Medicine, King Fahad Cardiac Center, King Saud University, Riyadh, Saudi Arabia. 15. ANMCO Research Center, Firenze, Italy. 16. Emergency Department, Hospital Clinic, and 'Emergency care: processes and diseases' Research Group, IDIBAPS, Barcelona, Catalonia, Spain. 17. Department of Cardiology, Hôpitaux Universitaire Saint Louis-Lariboisière, Assistance Publique des Hôpitaux de Paris, Paris, France. 18. Sociedad Argentina de Cardiologia, Area de Investigacion SAC Azcuenaga, Buenos Aires, Argentina. 19. Cardiology, Helsinki University and Helsinki University Hospital, Heart and Lung Center, Helsinki, Finland. 20. Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital, Basel, Switzerland. 21. Baylor College of Medicine, Houston, TX,, USA. 22. Emergency Department, Hôpitaux Universitaire Saint Louis-Lariboisière, Assistance Publique des Hôpitaux de Paris, Paris, France. 23. Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas, MO, USA. 24. Université Paris Diderot, Sorbonne Paris Cité, Paris, France. 25. UMR 942, INSERM, Paris, France.
Abstract
BACKGROUND: The interaction between chronic medications on admission and the association between serum potassium level and outcome in patients with acute heart failure (AHF) are unknown. METHODS: Observational intercontinental study of patients admitted with AHF. 15954 patients were included from 12 cohorts in 4 continents. Main outcome was 90-day mortality. Clinical presentation (medication use, hemodynamics, comorbidities), demographic, echocardiographic, and biochemical data on admission were recorded prospectively in each cohort, with prospective adjudication of outcomes. RESULTS: Positive and negative linear relationships between 90-day mortality and sK+ above 4.5 mmol/L (hyperkalemia) and below 3.5 mmol/L (hypo-kalemia) were observed. Hazard ratio for death was 1.46 [1.34-1.58] for hyperkalemia and 1.22 [1.06-1.40] for hypokalemia. In a fully adjusted model, only hyperkalemia remained associated with mortality (HR 1.03 [1.02-1.04] for each 0.1 mmol/l change of sK+ above 4.5 mmol/L). Interaction tests revealed that the association between hyperkalemia and outcome was significantly affected by chronic medications. The association between hyperkalemia and mortality was absent for patients treated with beta blockers and in those with preserved renal function. CONCLUSIONS: In patients with AHF, sK+ > 4.5 mmol/L appears to be associated with 90-day mortality. B-blockers have potentially a protective effect in the setting of hyperkalemia.
BACKGROUND: The interaction between chronic medications on admission and the association between serum potassium level and outcome in patients with acute heart failure (AHF) are unknown. METHODS: Observational intercontinental study of patients admitted with AHF. 15954 patients were included from 12 cohorts in 4 continents. Main outcome was 90-day mortality. Clinical presentation (medication use, hemodynamics, comorbidities), demographic, echocardiographic, and biochemical data on admission were recorded prospectively in each cohort, with prospective adjudication of outcomes. RESULTS: Positive and negative linear relationships between 90-day mortality and sK+ above 4.5 mmol/L (hyperkalemia) and below 3.5 mmol/L (hypo-kalemia) were observed. Hazard ratio for death was 1.46 [1.34-1.58] for hyperkalemia and 1.22 [1.06-1.40] for hypokalemia. In a fully adjusted model, only hyperkalemia remained associated with mortality (HR 1.03 [1.02-1.04] for each 0.1 mmol/l change of sK+ above 4.5 mmol/L). Interaction tests revealed that the association between hyperkalemia and outcome was significantly affected by chronic medications. The association between hyperkalemia and mortality was absent for patients treated with beta blockers and in those with preserved renal function. CONCLUSIONS: In patients with AHF, sK+ > 4.5 mmol/L appears to be associated with 90-day mortality. B-blockers have potentially a protective effect in the setting of hyperkalemia.
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