Sodium Zirconium Cyclosilicate Duration and Hyperkalemia-Related Healthcare Encounters in Patients with Heart Failure
Abiy Agiro1, Fan Mu2, Erin E Cook2
1AstraZeneca, 1800 Concord Pike, Wilmington, DE, 19850, USA. abiy.agiro@astrazeneca.com.
Insights
Long-term use of sodium zirconium cyclosilicate (SZC) significantly reduced hyperkalemia-related healthcare visits for patients with heart failure or cardio/renal dysfunction. This finding highlights the benefits of sustained SZC treatment in managing hyperkalemia.
Area of Science:
- Nephrology and Cardiology
- Pharmacoeconomics
- Health Services Research
Background:
- Patients with heart failure or cardio/renal dysfunction face elevated hyperkalemia risk.
- Sodium zirconium cyclosilicate (SZC) is a hyperkalemia treatment, but its impact on healthcare resource utilization based on treatment duration is not well-defined.
- The GALVANIZE Outcome study addresses this gap by comparing healthcare utilization between short-term and long-term SZC users.
Purpose of the Study:
- To assess healthcare resource utilization associated with short-term versus long-term outpatient SZC use.
- To compare hyperkalemia-related hospitalizations and emergency department visits in matched cohorts of SZC users with heart failure and cardio/renal dysfunction.
Main Methods:
- Retrospective analysis of a US claims database (July 2018–December 2022).
- Matched cohorts of long-term (>90 days) and short-term (≤30 days) outpatient SZC users with heart failure or cardio/renal dysfunction were created using exact and propensity score matching.
- Comparison of hyperkalemia-related hospitalizations/emergency department visits and hospitalizations during a 6-month follow-up period.
Main Results:
- Long-term SZC users demonstrated significantly fewer hyperkalemia-related hospitalizations or emergency department visits compared to short-term users.
- Reductions were observed in both heart failure (36%) and cardio/renal dysfunction (40%) cohorts.
- Significant reductions were also noted for hyperkalemia-related hospitalizations alone (39% in heart failure, 37% in cardio/renal dysfunction), all with p < 0.001.
Conclusions:
- Sustained, long-term use of sodium zirconium cyclosilicate is associated with substantial reductions in hyperkalemia-related healthcare utilization.
- These findings support the clinical and economic benefits of long-term SZC therapy in managing hyperkalemia in high-risk patient populations.
- The study underscores the importance of treatment duration in optimizing outcomes and resource utilization for SZC therapy.
Background And Objective:
Patients with heart failure or cardio/renal dysfunction (chronic kidney disease, end-stage kidney disease, or heart failure) are at increased risk of hyperkalemia. Sodium zirconium cyclosilicate (SZC) treats hyperkalemia, but the impact of SZC treatment duration on healthcare resource utilization in these populations is unclear. This study, GALVANIZE Outcome, assessed healthcare resource utilization associated with short-term versus long-term outpatient SZC use in matched cohorts of SZC users with heart failure and, separately, cardio/renal dysfunction.
Methods:
Data from a large US claims database (7/2018-12/2022) were used to identify adults with heart failure or cardio/renal dysfunction initiating outpatient SZC (index date). Long-term (> 90 days) and short-term SZC users (≤ 30 days) were matched on key baseline characteristics using a two-step approach: exact matching followed by propensity score matching. Rates of hyperkalemia-related hospitalizations or emergency department visits and hyperkalemia-related hospitalizations were compared between long-term and short-term SZC users during the follow-up from index to the earliest of 6 months post-index, end of data availability, new potassium binder use, or reinitiation of SZC post-discontinuation.
Results:
Among 942 matched heart failure pairs and 2892 matched cardio/renal pairs, long-term SZC users had fewer hyperkalemia-related hospitalizations or emergency department visits compared with short-term users, with reductions of 36% in the heart failure sample and 40% in the cardio/renal dysfunction sample; the respective reductions were 39% and 37% for hyperkalemia-related hospitalizations alone (all p < 0.001).
Conclusions:
Long-term SZC use is associated with significant reductions in hyperkalemia-related hospitalizations or emergency department visits compared with short-term use among patients with heart failure or cardio/renal dysfunction.
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