Hyperkalemia in acute heart failure: Short term outcomes from the EAHFE registry

Abstract

Objective: Both hyperkalemia (HK) and Acute Heart Failure (AHF) are associated with increased short-termmortality, and themanagement of eithermay exacerbate the other. As the relationship betweenHK and AHF is poorly described, our purpose was to determine the relationship between HK and short-term outcomes in Emergency Department (ED) AHF. Methods: The EAHFE Registry enrolls all ED AHF patients from 45 Spanish ED and records in-hospital and postdischarge outcomes. Our primary outcome was all-cause in-hospital death, with secondary outcomes of prolonged hospitalization (>7 days) and 7-day post-discharge adverse events (ED revisit, hospitalization, or death). Associations between serum potassium (sK) and outcomes were explored using logistic regression by restricted cubic spline (RCS) curves, with sK =4.0 mEq/L as the reference, adjusting by age, sex, comorbidities, patient baseline status and chronic treatments. Interaction analyses were performed for the primary outcome. Results: Of 13,606 ED AHF patients, the median (IQR) age was 83 (76-88) years, 54% were women, and the median (IQR) sK was 4.5 mEq/L (4.3-4.9) with a range of 4.0-9.9 mEq/L. In-hospital mortality was 7.7%, with prolonged hospitalization in 35.9%, and a 7-day post-discharge adverse event rate of 8.7%. Adjusted in-hospital mortality increased steadily from sK >= 4.8 (OR = 1.35, 95% CI = 1.01-1.80) to sK = 9.9 (8.41, 3.60-19.6). Nondiabetics with elevated sK had higher odds of death, while chronic treatment with mineralocorticoid-receptor antagonists exhibited a mixed effect. Neither prolonged hospitalization nor post-discharge adverse events was associated with sK. Conclusion: In ED AHF, initial sK>4.8mEq/Lwas independently associated with in-hospitalmortality, suggesting that this cohort may benefit from aggressive HK treatment. (c) 2023 Elsevier Inc. All rights reserved.