Associations of serumpotassiumlevels with mortality in chronic heart failure patients

Mette Aldahl; Anne Sofie Caroline Jensen; Line Davidsen; Matilde Alida Eriksen; Steen Møller Hansen; Berit Jamie Nielsen; Maria Lukacs Krogager; Lars Køber; Christian Torp-Pedersen; Peter Søgaard

doi:10.1093/eurheartj/ehx460

Associations of serumpotassiumlevels with mortality in chronic heart failure patients

Mette Aldahl^*, Anne Sofie Caroline Jensen, Line Davidsen, Matilde Alida Eriksen, Steen Møller Hansen, Berit Jamie Nielsen, Maria Lukacs Krogager, Lars Køber, Christian Torp-Pedersen, Peter Søgaard

^*Corresponding author for this work

Department of Clinical Medicine

84 Citations (Scopus)

Abstract

Aims Medication prescribed to patients suffering from chronic heart failure carries an increased risk of impaired potassium homeostasis. We examined the relation between different levels of serum potassium and mortality among patients with chronic heart failure. Methods and results From Danish National registries, we identified 19 549 patients with a chronic heart failure diagnosis who had a measurement of potassium within minimum 90 days after initiated medical treatment with loop diuretics and angiotensin converting enzyme inhibitors or angiotensin-II receptor blockers. All-cause mortality was examined according to eight predefined potassium levels: 2.8-3.4mmol/L, 3.5-3.8mmol/L, 3.9-4.1mmol/L, 4.2-4.4mmol/L, 4.5-4.7mmol/L, 4.8- 5.0mmol/L, 5.1-5.5mmol/L, and 5.6-7.4mmol/L. Follow-up was 90 days from potassium measurement. We estimated the risk of all-cause mortality using multivariable adjusted Cox proportional hazard model, with normal serum potassium level at 4.2-4.4mmol/L as reference. After 90 days, the mortality in the eight strata was 14.4, 8.0, 6.3, 5.0, 5.8, 7.9, 10.3, and 21.1% respectively. In multivariable adjusted analysis, patients with potassium levels of 2.8-3.4mmol/L [hazard ratio (HR): 3.16; confidence interval (CI): 2.43-4.11], 3.5-3.8mmol/L (HR: 1.62; CI: 1.31-1.99), 3.9-4.1mmol/ L (HR: 1.29; CI: 1.08-1.55), 4.8-5.0mmol/L (HR: 1.34; CI: 1.10-1.63), 5.1-5.5mmol/L (HR: 1.60; CI: 1.29-1.97), and 5.6-7.4mmol/L (HR: 3.31; CI: 2.61-4.20) had an increased risk of all-cause mortality. Conclusion Levels within the lower and upper levels of the normal serum potassium range (3.5-4.1 mmol/L and 4.8-5.0 mmol/ L, respectively) were associated with a significant increased short-term risk of death in chronic heart failure patients. Likewise, potassium below 3.5 mmol/L and above 5.0 mmol/L was also associated with increased mortality.

Original language	English
Journal	European Heart Journal
Volume	38
Issue number	38
Pages (from-to)	2890-2896
ISSN	0195-668X
DOIs	https://doi.org/10.1093/eurheartj/ehx460
Publication status	Published - 2017

Keywords

Chronic heart failure
Heart failure
Mortality
Serum potassium

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@article{ce7035d7abf747ee8761bda3725c99ab,

title = "Associations of serumpotassiumlevels with mortality in chronic heart failure patients",

abstract = "Aims Medication prescribed to patients suffering from chronic heart failure carries an increased risk of impaired potassium homeostasis. We examined the relation between different levels of serum potassium and mortality among patients with chronic heart failure. Methods and results From Danish National registries, we identified 19 549 patients with a chronic heart failure diagnosis who had a measurement of potassium within minimum 90 days after initiated medical treatment with loop diuretics and angiotensin converting enzyme inhibitors or angiotensin-II receptor blockers. All-cause mortality was examined according to eight predefined potassium levels: 2.8-3.4mmol/L, 3.5-3.8mmol/L, 3.9-4.1mmol/L, 4.2-4.4mmol/L, 4.5-4.7mmol/L, 4.8- 5.0mmol/L, 5.1-5.5mmol/L, and 5.6-7.4mmol/L. Follow-up was 90 days from potassium measurement. We estimated the risk of all-cause mortality using multivariable adjusted Cox proportional hazard model, with normal serum potassium level at 4.2-4.4mmol/L as reference. After 90 days, the mortality in the eight strata was 14.4, 8.0, 6.3, 5.0, 5.8, 7.9, 10.3, and 21.1% respectively. In multivariable adjusted analysis, patients with potassium levels of 2.8-3.4mmol/L [hazard ratio (HR): 3.16; confidence interval (CI): 2.43-4.11], 3.5-3.8mmol/L (HR: 1.62; CI: 1.31-1.99), 3.9-4.1mmol/ L (HR: 1.29; CI: 1.08-1.55), 4.8-5.0mmol/L (HR: 1.34; CI: 1.10-1.63), 5.1-5.5mmol/L (HR: 1.60; CI: 1.29-1.97), and 5.6-7.4mmol/L (HR: 3.31; CI: 2.61-4.20) had an increased risk of all-cause mortality. Conclusion Levels within the lower and upper levels of the normal serum potassium range (3.5-4.1 mmol/L and 4.8-5.0 mmol/ L, respectively) were associated with a significant increased short-term risk of death in chronic heart failure patients. Likewise, potassium below 3.5 mmol/L and above 5.0 mmol/L was also associated with increased mortality.",

keywords = "Chronic heart failure, Heart failure, Mortality, Serum potassium",

author = "Mette Aldahl and {Caroline Jensen}, {Anne Sofie} and Line Davidsen and Eriksen, {Matilde Alida} and Hansen, {Steen M{\o}ller} and Nielsen, {Berit Jamie} and Krogager, {Maria Lukacs} and Lars K{\o}ber and Christian Torp-Pedersen and Peter S{\o}gaard",

year = "2017",

doi = "10.1093/eurheartj/ehx460",

language = "English",

volume = "38",

pages = "2890--2896",

journal = "European Heart Journal",

issn = "0195-668X",

publisher = "Oxford University Press",

number = "38",

}

TY - JOUR

T1 - Associations of serumpotassiumlevels with mortality in chronic heart failure patients

AU - Aldahl, Mette

AU - Caroline Jensen, Anne Sofie

AU - Davidsen, Line

AU - Eriksen, Matilde Alida

AU - Hansen, Steen Møller

AU - Nielsen, Berit Jamie

AU - Krogager, Maria Lukacs

AU - Køber, Lars

AU - Torp-Pedersen, Christian

AU - Søgaard, Peter

PY - 2017

Y1 - 2017

N2 - Aims Medication prescribed to patients suffering from chronic heart failure carries an increased risk of impaired potassium homeostasis. We examined the relation between different levels of serum potassium and mortality among patients with chronic heart failure. Methods and results From Danish National registries, we identified 19 549 patients with a chronic heart failure diagnosis who had a measurement of potassium within minimum 90 days after initiated medical treatment with loop diuretics and angiotensin converting enzyme inhibitors or angiotensin-II receptor blockers. All-cause mortality was examined according to eight predefined potassium levels: 2.8-3.4mmol/L, 3.5-3.8mmol/L, 3.9-4.1mmol/L, 4.2-4.4mmol/L, 4.5-4.7mmol/L, 4.8- 5.0mmol/L, 5.1-5.5mmol/L, and 5.6-7.4mmol/L. Follow-up was 90 days from potassium measurement. We estimated the risk of all-cause mortality using multivariable adjusted Cox proportional hazard model, with normal serum potassium level at 4.2-4.4mmol/L as reference. After 90 days, the mortality in the eight strata was 14.4, 8.0, 6.3, 5.0, 5.8, 7.9, 10.3, and 21.1% respectively. In multivariable adjusted analysis, patients with potassium levels of 2.8-3.4mmol/L [hazard ratio (HR): 3.16; confidence interval (CI): 2.43-4.11], 3.5-3.8mmol/L (HR: 1.62; CI: 1.31-1.99), 3.9-4.1mmol/ L (HR: 1.29; CI: 1.08-1.55), 4.8-5.0mmol/L (HR: 1.34; CI: 1.10-1.63), 5.1-5.5mmol/L (HR: 1.60; CI: 1.29-1.97), and 5.6-7.4mmol/L (HR: 3.31; CI: 2.61-4.20) had an increased risk of all-cause mortality. Conclusion Levels within the lower and upper levels of the normal serum potassium range (3.5-4.1 mmol/L and 4.8-5.0 mmol/ L, respectively) were associated with a significant increased short-term risk of death in chronic heart failure patients. Likewise, potassium below 3.5 mmol/L and above 5.0 mmol/L was also associated with increased mortality.

AB - Aims Medication prescribed to patients suffering from chronic heart failure carries an increased risk of impaired potassium homeostasis. We examined the relation between different levels of serum potassium and mortality among patients with chronic heart failure. Methods and results From Danish National registries, we identified 19 549 patients with a chronic heart failure diagnosis who had a measurement of potassium within minimum 90 days after initiated medical treatment with loop diuretics and angiotensin converting enzyme inhibitors or angiotensin-II receptor blockers. All-cause mortality was examined according to eight predefined potassium levels: 2.8-3.4mmol/L, 3.5-3.8mmol/L, 3.9-4.1mmol/L, 4.2-4.4mmol/L, 4.5-4.7mmol/L, 4.8- 5.0mmol/L, 5.1-5.5mmol/L, and 5.6-7.4mmol/L. Follow-up was 90 days from potassium measurement. We estimated the risk of all-cause mortality using multivariable adjusted Cox proportional hazard model, with normal serum potassium level at 4.2-4.4mmol/L as reference. After 90 days, the mortality in the eight strata was 14.4, 8.0, 6.3, 5.0, 5.8, 7.9, 10.3, and 21.1% respectively. In multivariable adjusted analysis, patients with potassium levels of 2.8-3.4mmol/L [hazard ratio (HR): 3.16; confidence interval (CI): 2.43-4.11], 3.5-3.8mmol/L (HR: 1.62; CI: 1.31-1.99), 3.9-4.1mmol/ L (HR: 1.29; CI: 1.08-1.55), 4.8-5.0mmol/L (HR: 1.34; CI: 1.10-1.63), 5.1-5.5mmol/L (HR: 1.60; CI: 1.29-1.97), and 5.6-7.4mmol/L (HR: 3.31; CI: 2.61-4.20) had an increased risk of all-cause mortality. Conclusion Levels within the lower and upper levels of the normal serum potassium range (3.5-4.1 mmol/L and 4.8-5.0 mmol/ L, respectively) were associated with a significant increased short-term risk of death in chronic heart failure patients. Likewise, potassium below 3.5 mmol/L and above 5.0 mmol/L was also associated with increased mortality.

KW - Chronic heart failure

KW - Heart failure

KW - Mortality

KW - Serum potassium

U2 - 10.1093/eurheartj/ehx460

DO - 10.1093/eurheartj/ehx460

M3 - Journal article

AN - SCOPUS:85032733939

SN - 0195-668X

VL - 38

SP - 2890

EP - 2896

JO - European Heart Journal

JF - European Heart Journal

IS - 38

ER -

Associations of serumpotassiumlevels with mortality in chronic heart failure patients

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