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Outcomes and Patterns Related to Magnesium in Acute Heart Failure: A Population-Based Study
Robert Margaryan1, Sunjidatul Islam1, Douglas Dover1
1Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada.
Insights
Magnesium testing is common in heart failure (HF) patients, with abnormal levels linked to worse outcomes. Intravenous magnesium replacement showed increased short-term mortality and hospitalization risks in this study.
Area of Science:
- Cardiology
- Clinical Chemistry
- Pharmacology
Background:
- The role of magnesium in heart failure (HF) management and prognosis is not well-defined.
- Magnesium testing and treatment are frequently employed in HF care.
- Uncertainty exists regarding the impact of magnesium levels and interventions on HF outcomes.
Purpose of the Study:
- To investigate the frequency of serum magnesium testing in acute heart failure (HF) patients.
- To determine the association between magnesium levels (hypomagnesemia and hypermagnesemia) and HF outcomes.
- To evaluate the impact of intravenous (IV) magnesium replacement on mortality and hospitalization in HF patients.
Main Methods:
- Retrospective cohort study utilizing linked administrative data from April 2012 to March 2020.
- Inclusion of patients with a primary diagnosis of acute heart failure (HF) in emergency departments or hospitals.
- Analysis of outcomes including all-cause mortality, cause-specific death, hospitalization, emergency department visits, and physician claims, alongside magnesium testing rates and hypomagnesemia prevalence.
Main Results:
- Serum magnesium testing was performed in 58.7% of 78,957 acute HF episodes.
- Abnormal magnesium levels (<0.75 mmol/L or >0.95 mmol/L) were observed in 31.7% and 11.5% of tested patients, respectively.
- Both low (<0.70 mmol/L) and high (>0.86 mmol/L) magnesium levels were independently associated with increased mortality.
- Intravenous (IV) magnesium administration, given to 13.7% of tested patients, was associated with higher short-term mortality (HR 1.66) and hospitalization risk (HR 1.36) after multivariable adjustment.
Conclusions:
- Serum magnesium testing is prevalent in acute heart failure (HF) presentations.
- Both low and high serum magnesium levels correlate with adverse outcomes in HF patients.
- Intravenous magnesium replacement appears linked to worse short-term outcomes, necessitating further investigation.
Background:
The significance of magnesium as a treatment or prognostic factor in heart failure (HF) remains uncertain despite frequent use. We evaluated the frequency and outcomes of magnesium testing, hypomagnesemia, and intravenous (IV) replacement in a large population-based cohort.
Methods:
This retrospective cohort study used linked administrative data (April 2012 to March 2020). Patients with a primary diagnosis of HF in the emergency department (ED) or hospital were included. Outcomes included all-cause and cause-specific death and hospitalisation. Secondary outcomes included ED visits and physicians claims. We also examined rates of serum magnesium testing and hypomagnesemia.
Results:
Among 78,957 acute HF episodes (in 42,763 patients), 58.7% included serum magnesium testing. Of those tested, serum magnesium levels were < 0.75 mmol/L in 31.7%, 0.75-0.95 mmol/L in 56.8% and > 0.95 mmol/L in 11.5%. Magnesium levels (per 0.02 mmol/L increase) were independently associated with mortality when < 0.70 mmol/L (hazard ratio [HR] 0.99, 95% confidence interval [CI] 0.98-0.99; P < 0.001) or > 0.86 mmol/L (HR 1.04, 95% CI 1.03-1.04; P < 0.001). IV magnesium was administered to 13.7% (n = 6333) of tested patients, including 29.7% without hypomagnesemia. After multivariable adjustment, IV magnesium was associated with a higher short-term mortality (HR 1.66, 95% CI 1.4-1.96; P < 0.0001) and hospitalisation risk (HR 1.36, 95% CI 1.13-1.63; P < 0.001).
Conclusions:
Serum magnesium testing is common in patients presenting to the ED or hospital with HF, and low or high magnesium is associated with worse outcomes. Replacement with IV magnesium was associated with worse outcomes even after adjustment, warranting further study.
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