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Potassium as a predictor of outcome in acute heart failure and preserved ejection fraction
Session:
Painel 2 - Insuficiência Cardíaca 10
Speaker:
Diogo Faustino
Congress:
CPC 2020
Topic:
D. Heart Failure
Theme:
11. Acute Heart Failure
Subtheme:
11.2 Acute Heart Failure – Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
Diogo Faustino; Gonçalo Lopes Da Cunha; Pedro Custódio; Tiago Pacheco; Laura Moreira; Sara Trevas; Marta Roldão; Luis Campos; Célia Henriques; Inês Araújo; Cândida Fonseca
Abstract
<p><strong>Background:</strong></p> <p>Following the approval of new potassium binders, there has been a renewed interest on serum potassium (K) in patients with heart failure and a reduced ejection fraction (HFrEF). The association between serum K levels and outcome in this population was previously studied, frequently with inconsistent results. Low baseline levels and acute decreases in serum K during hospital stay have been linked to increased mortality. There is some evidence that high normal K values may be associated with a more favorable outcome. Not much is known about the predictive value of K in patients with HF and preserved ejection fraction (HFpEF), a population where hospitalizations and mortality are more commonly associated with co-morbidities and who are also frequently treated with neurohumoral inhibitors. Our aim was to assess the impact of K levels on the outcome of HPpEF patients.</p> <p><strong>Methods:</strong></p> <p>Single-center, retrospective study including patients admitted for decompensated HF to a dedicated HF unit between 2016 and 2018. Patients with HFrEF were excluded. K levels were recorded at admission and discharge. Long-term all-cause mortality and HF hospitalization were assessed on follow-up.</p> <p><strong>Results:</strong></p> <p>200 patients were included. Mean age: 79.7(72.5–84.8) years; 47% male. 89.4% had hypertension, 41.9% diabetes; 28.5% ischemic heart disease; Avg. creatinine on admission 1.28mg/dL (0.95–1.71) with estimated glomerular filtration rate (eGFR) 45.02±0.4ml/min/1.73m<sup>2</sup>. Avg. serum K on admission 4.35±0.66mmol/L; at discharge: 4.31±0.55mmol/L. Avg. follow-up 18.9±12.2months. In univariate analysis, a higher K at admission was associated with increased prevalence of hospitalization for HF on follow-up (HR 1.02 x, 95% CI 1.002-1.038, p=0.031) (figure 1). After adjustment for potential confounders (diabetes, GFR, thiazides, MRAs, hemoglobin), a lower value of K (< 4.5mmol/L) was a significant predictor of lesser hospitalization for HF (HR 0.274, 95% CI 0.1-0.747, p=0.011). On the other hand, a K level between 4.5 and 5.5mmol/L at discharge was an independent predictor of decreased long-term mortality, when compared to discharge K levels > 5.5 or < 4.5mmol/L (HR 0.50 95%CI 0.31–0.82 p=0.006).</p> <p><strong>Conclusion:</strong></p> <p>In this population with HFpEF, K on admission was an independent predictor of long-term hospitalization. We observed a U-shaped relationship between K at discharge and mortality (greater events occurring outside of the 4.5 – 5.5mmol/L range), as previously reported on other populations (both cardiovascular and non-cardiovascular).</p> <p> </p> <p>Fig.1 Kaplan-Meier curve; Relationship between K on admission and long-term hospitalization on follow-up.</p>
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