title: Serum Potassium Levels and Outcome in Patients With Chronic Heart Failure.
abstract: Potassium levels are often abnormal in patients with heart failure (HF) and have a detrimental effect on clinical outcome. We evaluated potassium levels in a real-world cohort of patients with HF and its effect on mortality. All patients with a diagnosis of HF at a health maintenance organization were evaluated and followed for cardiac-related hospitalizations and death. The cohort consisted of 6,073 patients with HF. Mean potassium levels were 4.57 ± 0.53 mmol/L. Most patients (68%) had potassium levels in the normal range (4.0 to 5.0 mmol/L). High-normal potassium levels (5.0 to 5.5) were present in 17% of the patients, low potassium levels (<4.0) in 11%, and hyperkalemia (K ≥5.5) in 4%. Mean follow-up was 576 days. The overall mortality rate during this period was 14%. Survival rate by Kaplan-Meier analysis demonstrated that hypokalemia (K ≤3.5) was associated with the lowest survival rate. Survival was highest in patients with high-normal potassium levels. Cox regression analysis after adjustment for significant predictors including co-morbidities and standard HF drug therapies demonstrated that high-normal potassium levels were independently associated with reduced mortality compared with normal reference levels (hazard ratio 0.78, 95 confidence interval [CI] 0.64 to 0.95, p = 0.01). Subgroup analysis showed improved outcome with high-normal potassium levels in patients with reduced renal function, spironolactone, and loop diuretic therapy. In conclusion, potassium levels in the high-normal range appear to be safe and are associated with an improved outcome in patients with HF.
authors.affiliation: Heart Failure Center, Heart Institute, Hadassah University Hospital, Jerusalem, Israel.
authors.forename: Sarah
authors.initials: S
authors.lastname: Hoss
authors.affiliation: Heart Failure Center, Heart Institute, Hadassah University Hospital, Jerusalem, Israel.
authors.forename: Yair
authors.initials: Y
authors.lastname: Elizur
authors.affiliation: Heart Failure Center, Heart Institute, Hadassah University Hospital, Jerusalem, Israel.
authors.forename: David
authors.initials: D
authors.lastname: Luria
authors.affiliation: Heart Failure Center, Heart Institute, Hadassah University Hospital, Jerusalem, Israel.
authors.forename: Andre
authors.initials: A
authors.lastname: Keren
authors.affiliation: Heart Failure Center, Heart Institute, Hadassah University Hospital, Jerusalem, Israel.
authors.forename: Chaim
authors.initials: C
authors.lastname: Lotan
authors.affiliation: Heart Failure Center, Heart Institute, Hadassah University Hospital, Jerusalem, Israel. Electronic address: igotsman@bezeqint.net.
authors.forename: Israel
authors.initials: I
authors.lastname: Gotsman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D015331:Cohort Studies; D004232:Diuretics / Q000627:therapeutic use; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000401:mortality; D006801:Humans; D006947:Hyperkalemia / Q000097:blood / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D009026:Mortality; D011188:Potassium / Q000097:blood*; D011379:Prognosis; D016016:Proportional Hazards Models; D065840:Protective Factors; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology; D049994:Sodium Potassium Chloride Symporter Inhibitors / Q000627:therapeutic use; D013148:Spironolactone / Q000627:therapeutic use; D015996:Survival Rate
chemical_list: D004232:Diuretics; D049994:Sodium Potassium Chloride Symporter Inhibitors; D013148:Spironolactone; D011188:Potassium