Skip to Main content Skip to Navigation
Journal articles

Unravelling the interplay between hyperkalaemia, renin–angiotensin–aldosterone inhibitor use and clinical outcomes. Data from 9222 chronic heart failure patients of the ESC‐HFA‐EORP Heart Failure Long‐Term Registry

Patrick Rossignol 1, 2, 3, 4 Mitja Lainscak 5 Maria Crespo-Leiro 6 Cécile Laroche 7 Massimo Piepoli 8 Gerasimos Filippatos 9 Giuseppe Rosano 10 Gianluigi Savarese 11 Stefan Anker 12, 13 Frank Ruschitzka 14 Andrew Coats 10 Alexandre Mebazaa 3, 4, 15, 16 Theresa Mcdonagh 17 Ana Sahuquillo 18 Maria Penco 19 Aldo Maggioni 7, 20 Lars Lund 11 Behalf Of The Heart Failure Long-Term Registry Investigators Group
Abstract : Aims: We assessed the interplay between hyperkalaemia (HK) and renin-angiotensin-aldosterone system inhibitor (RAASi) use, dose and discontinuation, and their association with all-cause or cardiovascular death in patients with chronic heart failure (HF). We hypothesized that HK-associated increased death may be related to RAASi withdrawal. Methods and results: The ESC-HFA-EORP Heart Failure Long-Term Registry was used. Among 9222 outpatients (HF with reduced ejection fraction: 60.6%, HF with mid-range ejection fraction: 22.9%, HF with preserved ejection fraction: 16.5%) from 31 countries, 16.6% had HK (≥5.0 mmol/L) at baseline. Angiotensin-converting enzyme inhibitor (ACEi) or angiotensin receptor blocker (ARB) was used in 88.3%, a mineralocorticoid receptor antagonist (MRA) in 58.7%, or a combination in 53.2%; of these, at ≥50% of target dose in ACEi: 61.8%; ARB: 64.7%; and MRA: 90.3%. At a median follow-up of 12.2 months, there were 789 deaths (8.6%). Both hypokalaemia and HK were independently associated with higher mortality, and ACEi/ARB prescription at baseline with lower mortality. MRA prescription was not retained in the model. In multivariable analyses, HK at baseline was independently associated with MRA non-prescription at baseline and subsequent discontinuation. When considering subsequent discontinuation of RAASi (instead of baseline use), HK was no longer found associated with all-cause deaths. Importantly, all RAASi (ACEi, ARB, or MRA) discontinuations were strongly associated with mortality. Conclusions: In HF, hyper- and hypokalaemia were associated with mortality. However, when adjusting for RAASi discontinuation, HK was no longer associated with mortality, suggesting that HK may be a risk marker for RAASi discontinuation rather than a risk factor for worse outcomes.
Complete list of metadata

https://hal.univ-lorraine.fr/hal-03038400
Contributor : Erwan Bozec <>
Submitted on : Friday, December 4, 2020 - 9:49:06 AM
Last modification on : Wednesday, June 9, 2021 - 4:02:06 PM
Long-term archiving on: : Friday, March 5, 2021 - 6:09:10 PM

Files

HF_LT_Hyperkalemia_Rossignol_E...
Files produced by the author(s)

Identifiers

Citation

Patrick Rossignol, Mitja Lainscak, Maria Crespo-Leiro, Cécile Laroche, Massimo Piepoli, et al.. Unravelling the interplay between hyperkalaemia, renin–angiotensin–aldosterone inhibitor use and clinical outcomes. Data from 9222 chronic heart failure patients of the ESC‐HFA‐EORP Heart Failure Long‐Term Registry. European Journal of Heart Failure, Oxford University Press (OUP), 2020, 22 (8), pp.1378-1389. ⟨10.1002/ejhf.1793⟩. ⟨hal-03038400⟩

Share

Metrics

Record views

188

Files downloads

887