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Patiromer as a Cornerstone for Hyperkalemia Management in Spironolactone-Untreated Patients - A Real-World Perspective
Session:
Sessão de Posters 21 - Insuficiência cardíaca aguda
Speaker:
Ana Filipa Mesquita Gerardo
Congress:
CPC 2024
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
11. Acute Heart Failure
Subtheme:
11.4 Acute Heart Failure– Treatment
Session Type:
Cartazes
FP Number:
---
Authors:
Filipa Gerardo; Mariana Passos; Inês Fialho; Inês Miranda; Carolina Mateus; Mara Sarmento; Joana Lima Lopes; David Roque
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-family:"Calibri",sans-serif">Introduction and Aim:</span></strong></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-family:"Calibri",sans-serif">Heart failure (HF) remains a leading cause of morbidity and mortality worldwide. The DIAMOND trial (Patiromer for the Management of Hyperkalemia in Subjects Receiving RAASi for HFrEF) showed that patiromer was effective at maintaining lower serum potassium levels among patients with HF with reduced ejection fraction (HFrEF) receiving RAASi therapy. This study aims to investigate the potential use of patiromer, in real-world HF pts.</span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-family:"Calibri",sans-serif">Methods:</span></strong></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-family:"Calibri",sans-serif">We conducted a retrospective study of hospitalized acute HF patients from February 2021 to September 2023 . Among this cohort, we applied the enrollment criteria of the DIAMOND trial. Patients with ≥18 years, in New York Heart Association (NYHA) Class II–IV and a left ventricular ejection fraction (LVEF) ≤40% were considered for inclusion. Patients were excluded if they had an estimated glomerular filtration rate (GFR) <30 ml/min/1.73 m2, systolic blood pressure <90 mmHg or symptomatic hypotension. Patients were then eligible to start patiromer therapy if 1) they had hyperkalemia (serum potassium [K+] >5.0 mmol/l) while receiving an angiotensin-converting enzyme inhibitor (ACEi), angiotensin receptor blocker (ARB), angiotensin receptor-neprilysin inhibitor (ARNi), and/or MRA therapy; or 2) if they were normokalemic at screening but had a history of dose reduction or discontinuation of the RAASi therapy due to hyperkalemia in the previous 12 months.</span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-family:"Calibri",sans-serif">Results:</span></strong></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-family:"Calibri",sans-serif"><span style="color:#212529">A total of 283 electronic medical charts were reviewed. Of these 179</span></span><span style="font-family:"Calibri",sans-serif"> HF patients met the inclusion criteria and exclusion criteria for patiromer therapy. 68.2% (n=122) were males, mean age was 64.2±3.2years, mean LVEF 28.9±11.6%, median GFR 64 [IQR 49-86.5] ml/min/1.73 m2 and median K+ was 4.5 [IQR 4.1-4.8]. Regarding the 1<sup>st</sup> eligibility criteria, 23.46% (n=42) of patients were discharged without spironolactone due to hyperkalemia at discharge or during hospital stay, and 5 of these (11.6%) did not receive ACEI/ARB/ARNi for the same reason. Regarding the 2<sup>nd</sup> eligibility criteria, 3.5% (n=6) of patients were discharged with a reduction of MRA dose due to hyperkalemia. In total, 27.8% (n=48) patients could have been started on patiromer therapy and were discharged with suboptimal MRA treatment.</span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-family:"Calibri",sans-serif">Conclusion:</span></strong></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-family:"Calibri",sans-serif">This study validates that in the real-world, the incorporation of potassium binders like patiromer may contribute to optimizing the therapeutic landscape for a significant proportion of HF patients receiving suboptimal MRA treatment due to hyperkalemia</span></span></span></p>
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