Francesc Formiga1, David Chivite2, Xavier Corbella3, Alicia Conde-Martel4, José Carlos Arévalo-Lorido5, Joan Carles Trullàs6, José Pérez Silvestre7, Sara Carrascosa García7, Luis Manzano8, Manuel Montero-Pérez-Barquero9. 1. Geriatric Unit, Internal Medicine Department, Hospital Universitari de Bellvitge-IDIBELL, L' Hospitalet de Llobregat, Barcelona, Spain. Electronic address: fformiga@bellvitgehospital.cat. 2. Geriatric Unit, Internal Medicine Department, Hospital Universitari de Bellvitge-IDIBELL, L' Hospitalet de Llobregat, Barcelona, Spain. 3. 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. 4. Internal Medicine Department, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Las Palmas, Spain. 5. Internal Medicine Department, Hospital Comarcal de Zafra, Zafra, Badajoz, Spain. 6. Intenal Medicine Service, Hospital d'Olot i comarcal de la Garrtoxa, Olot, Girona, Spain and Medical Science Department, Universitat de Girona, Girona, Spain. 7. Internal Medicine Department, Hospital General Universitario de Valencia, Valencia, Spain. 8. Internal Medicine Department, Hospital Universitario Ramón y Cajal, Universidad de Alcalá (IRYCIS), Madrid, Spain. 9. Internal Medicine Department, IMIBIC/Hospital Reina Sofía, Universidad de Córdoba, Córdoba, Spain.
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.
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 hypokalemicpatients). 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 hyperkalemicpatients and 0.96 (0.75-1.23); p = .751in hypokalemicpatients. 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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