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Serum Potassium Levels and Mortality in Hospitalized Heart Failure Patients
Bo-Ping Huang1, Lang Zhao1, Xue-Mei Zhao1
1Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College (CAMS & PUMC), 100037 Beijing, China.
Insights
Serum potassium levels significantly impact mortality risk in hospitalized heart failure patients. Both low and very high potassium levels are associated with increased all-cause mortality, suggesting a narrow therapeutic range is crucial.
Area of Science:
- Cardiology
- Internal Medicine
- Clinical Research
Background:
- Heart failure (HF) is a major cause of hospitalization and mortality.
- Electrolyte balance, particularly serum potassium (K+), plays a critical role in cardiovascular function.
- Understanding the relationship between serum K+ levels and outcomes in HF patients is essential for optimizing treatment.
Purpose of the Study:
- To investigate the association between serum potassium levels and all-cause mortality in patients hospitalized with heart failure.
- To determine if specific potassium level ranges (hypokalemia or hyperkalemia) are linked to increased mortality risk.
- To identify a potential optimal serum potassium range for hospitalized HF patients.
Main Methods:
- A cohort of 3114 hospitalized heart failure patients was analyzed.
- Patients were categorized into four groups based on serum potassium quartiles before discharge.
- All-cause mortality was assessed at 90 days, 2 years, and during maximal follow-up.
Main Results:
- Patients in the highest potassium quartile (Q4, K+ ≥ 4.52 mmol/L) exhibited poorer cardiac function and lower ejection fractions.
- Multivariate analysis revealed a significantly increased risk of all-cause mortality in the Q4 group at all follow-up periods (HR: 1.28 at maximal follow-up, p=0.002).
- Both hypokalemia and hyperkalemia were independently associated with elevated HF mortality risk.
Conclusions:
- Serum potassium levels demonstrate a J-shaped association with all-cause mortality in hospitalized heart failure patients.
- Both hypokalemia and potassium levels ≥ 4.52 mmol/L are linked to increased short-term and long-term mortality.
- A narrow target range for serum potassium is suggested for optimizing outcomes in HF patients.
Background:
To assess the link between serum potassium ( ) and all-cause mortality in hospitalized heart failure (HF) patients.
Methods:
Hospitalized HF patients (n = 3114) were analyzed at the Fuwai Hospital Heart Failure Center. Before discharge, HF patients were divided into four groups according to the level quartiles: 3.96 mmol/L (Q1), 3.96 4.22 mmol/L (Q2), 4.22 4.52 mmol/L (Q3), and 4.52 mmol/L (Q4). At 90 days, 2 years, and maximal follow-up, all-cause mortality was the primary outcome.
Results:
Patients with HF in the Q4 group had worse cardiac function, higher N-terminal pro-B-type natriuretic peptide levels, lower left ventricular ejection fractions and lower estimated glomerular filtration rates than patients in the Q2 group. In the multivariate-adjusted Cox analysis, the mortality assessed during the 90-day, 2-year, and maximal follow-up examinations increased in the Q4 group of HF patients but not in the Q1 and Q3 groups. The Q4 group had a 28% (hazard ratio [HR]: 1.28, 95% confidence interval [CI]: 1.09-1.49, p = 0.002) higher risk of all-cause mortality at maximum follow-up. Hypokalemia and hyperkalemia were linked to increased HF mortality risk at the 90-day, 2-year, and maximal follow-up periods.
Conclusions:
Serum levels had a J-shaped association with all-cause mortality in HF patients. Both hypokalemia and a level of 4.52 mmol/L were associated with increased all-cause mortality in the short term and long term, suggesting a narrow target range in HF patients.
Clinical Trial Registration:
Unique Identifier: NCT02664818; URL: clinicaltrials.gov.
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