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Association between potassium level and outcomes in heart failure with reduced ejection fraction: a cohort study from the Swedish Heart Failure Registry
Inova Heart and Vasc Inst, VA 22042 USA; Duke Univ, NC 27706 USA.
Karolinska Inst, Sweden.
Duke Univ, NC 27706 USA.
Karolinska Inst, Sweden.
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2020 (English)In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844, Vol. 22, no 8, p. 1390-1398Article in journal (Refereed) Published
Abstract [en]

Aims Hyperkalaemia and hypokalaemia are common in heart failure and associated with worse outcomes. However, the optimal potassium range is unknown. We sought to determine the optimal range of potassium in patients with heart failure and reduced ejection fraction (amp;lt; 40%) by exploring the relationship between baseline potassium level and short- and long-term outcomes using the Swedish Heart Failure Registry from 1 January 2006 to 31 December 2012. Methods and results We assessed the association between baseline potassium level and all-cause mortality at 30 days, 12 months, and maximal follow-up, in uni- and multivariable stratified and restricted cubic spline Cox regressions. Of 13 015 patients, 93.3% had potassium 3.5-5.0 mmol/L, 3.7% had potassium amp;lt;3.5 mmol/L, and 3.0% had potassium amp;gt;5.0 mmol/L. Potassium 5.0 mmol/L were more common with lower estimated glomerular filtration rate and heart failure of longer duration and greater severity. The potassium level associated with the lowest hazard risk for mortality at 30 days, 12 months, and maximal follow-up was 4.2 mmol/L, and there was a steep increase in risk with both higher and lower potassium levels. In adjusted strata analyses, lower potassium was independently associated with all-cause mortality at 12 months and maximal follow-up, while higher potassium levels only increased risk at 30 days. Conclusion In this nationwide registry, the relationship between potassium and mortality was U-shaped, with an optimal potassium value of 4.2 mmol/L. After multivariable adjustment, hypokalaemia was associated with increased long-term mortality but hyperkalaemia was associated with increased short-term mortality.

Place, publisher, year, edition, pages
WILEY , 2020. Vol. 22, no 8, p. 1390-1398
Keywords [en]
Heart failure; Potassium; Outcomes
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:liu:diva-164255DOI: 10.1002/ejhf.1757ISI: 000514492700001PubMedID: 32078214OAI: oai:DiVA.org:liu-164255DiVA, id: diva2:1414301
Note

Funding Agencies|Swedish Federal Government through the Swedish Association of Local Authorities and Regions; Swedish Research CouncilSwedish Research Council [2013-23897-104604-23, 523-2014-2336, 2019-01059]; Swedish Heart Lung FoundationSwedish Heart-Lung Foundation [20120321, 20150557]; Stockholm County CouncilStockholm County Council [20110120, 20140220]

Available from: 2020-03-12 Created: 2020-03-12 Last updated: 2021-04-30

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Dahlström, Ulf

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Division of Diagnostics and Specialist MedicineFaculty of Medicine and Health SciencesDepartment of Cardiology in Linköping
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European Journal of Heart Failure
Cardiac and Cardiovascular Systems

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