Serum Potassium Levels and Outcome in Acute Heart Failure (Data from the PROTECT and COACH Trials).
Serum potassium is routinely measured at admission for acute heart failure (AHF), but information on association with clinical variables and prognosis is limited. Potassium measurements at admission were available in 1,867 patients with AHF in the original cohort of 2,033 patients included in the Patients Hospitalized with acute heart failure and Volume Overload to Assess Treatment Effect on Congestion and Renal FuncTion trial. Patients were grouped according to low potassium (<3.5 mEq/l), normal potassium (3.5 to 5.0 mEq/l), and high potassium (>5.0 mEq/l) levels. Results were verified in a validation cohort of 1,023 patients. Mean age of patients was 71 ± 11 years, and 66% were men. Low potassium was present in 115 patients (6%), normal potassium in 1,576 (84%), and high potassium in 176 (9%). Potassium levels increased during hospitalization (0.18 ± 0.69 mEq/l). Patients with high potassium more often used angiotensin-converting enzyme inhibitors and mineralocorticoid receptor antagonists before admission, had impaired baseline renal function and a better diuretic response (p = 0.005), independent of mineralocorticoid receptor antagonist usage. During 180-day follow-up, a total of 330 patients (18%) died. Potassium levels at admission showed a univariate linear association with mortality (hazard ratio [log] 2.36, 95% confidence interval 1.07 to 5.23; p = 0.034) but not after multivariate adjustment. Changes of potassium levels during hospitalization or potassium levels at discharge were not associated with outcome after multivariate analysis. Results in the validation cohort were similar to the index cohort. In conclusion, high potassium levels at admission are associated with an impaired renal function but a better diuretic response. Changes in potassium levels are common, and overall levels increase during hospitalization. In conclusion, potassium levels at admission or its change during hospitalization are not associated with mortality after multivariate adjustment.
Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Jasper
J
Tromp
Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Jozine M
JM
Ter Maaten
Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Kevin
K
Damman
Inova Heart and Vascular Institute, Falls Church, Virginia.
Christopher M
CM
O'Connor
Department of Cardiology, University of Brescia, Brescia, Italy.
Marco
M
Metra
Cardiovascular Research Center, University of Iowa Carver College of Medicine, Iowa City, Iowa.
Howard C
HC
Dittrich
Department of Heart Diseases, Medical University, Clinical Military Hospital, Wroclaw, Poland.
Piotr
P
Ponikowski
Department of Cardiology, University of California at San Francisco and San Francisco Veterans Affairs Medical Center, San Francisco, California.
John R
JR
Teerlink
Momentum Research, Durham, North Carolina.
Gad
G
Cotter
Momentum Research, Durham, North Carolina.
Beth
B
Davison
Department of Cardiology, University of Hull, Kingston Upon Hull, United Kingdom.
John G F
JG
Cleland
Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Michael M
MM
Givertz
Merck & Co., Inc., Kenilworth, New Jersey.
Daniel M
DM
Bloomfield
Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Faculty of Health and Medical Sciences, Linköping University, Linköping, Sweden.
Martje H L
MH
van der Wal
Faculty of Health and Medical Sciences, Linköping University, Linköping, Sweden.
Tiny
T
Jaarsma
Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Dirk J
DJ
van Veldhuisen
Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Hans L
HL
Hillege
Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Adriaan A
AA
Voors
Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. Electronic address: p.van.der.meer@umcg.nl.
Peter
P
van der Meer
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D015331:Cohort Studies; D004232:Diuretics / Q000627:therapeutic use; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000401:mortality* / Q000628:therapy; D006760:Hospitalization; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use; D011188:Potassium / Q000097:blood*; D015203:Reproducibility of Results; D016896:Treatment Outcome; D014970:Xanthines / Q000627:therapeutic use
D000806:Angiotensin-Converting Enzyme Inhibitors; D004232:Diuretics; D000451:Mineralocorticoid Receptor Antagonists; D014970:Xanthines; C073525:rolofylline; D011188:Potassium