Author + information
- Lauren Beth Coopera,b,
- Lina Bensona,b,
- Robert Mentza,b,
- Gianluigi Savaresea,b,
- Adam DeVorea,b,
- Juan Jesus Carreroa,b,
- Ulf Dahlstroma,b,
- Stefan Ankera,b,
- Mitja Lainscaka,b,
- Adrian Hernandeza,b,
- Bertram Pitta,b and
- Lars Lunda,b
Background: Hyper- and hypokalemia are common in heart failure (HF) and associated with worse outcomes. Normal values are established in the general population (3.5-5.0mmol/L), but the optimal potassium (K+) range in patients with HF is unknown.
Methods: Using the Swedish HF Registry, we studied HF patients with reduced ejection fraction (EF<40%) from 1/1/2006-12/31/2012, and assessed the association between serum K+ and all-cause mortality in uni- and multivariable stratified and restricted cubic spline Cox regressions.
Results: Of 12,420 patients, 93.2% had K+ 3.5-5.0, 3.8% had K+ <3.5, 2.5% had K+ 5.1-5.5, and 0.5% had K+ 5.5-6.5mmol/L. K+ <3.5 and >5.0 were more common with worse renal function and HF of longer duration and greater severity. Over a median follow-up of 2 years, in adjusted strata analyses, compared to K+ 3.5-5.0, lower potassium was associated with increased risk of mortality (K+ <3.5: HR 1.24, 95% CI 1.07-1.44), but higher potassium was not (K+ 5.1-5.5: HR 1.06, 95% CI 0.88-1.27 and K+ 5.5-6.5: HR 0.87, 95% CI 0.58-1.28). In adjusted spline analyses, the HR for death was <1.0 for K+ range 3.9-4.5, and the optimal K+ was 4.2 (Figure).
Conclusions: In this nationwide registry, the relationship between K+ and mortality was U-shaped, with an optimal K+ range much narrower (3.9-4.5mmol/L) than the normal reference range. After multivariable adjustment, hypokalemia was associated with increased long-term mortality. Associations with acute and short-term outcomes require further study.
Moderated Poster Contributions
Heart Failure and Cardiomyopathies Moderated Poster Theater, Poster Hall, Hall C
Friday, March 17, 2017, 11:45 a.m.-11:55 a.m.
Session Title: Why Can't We Be Friends? Controversies in Heart Failure Management
Abstract Category: 13. Heart Failure and Cardiomyopathies: Clinical
Presentation Number: 1137M-17
- 2017 American College of Cardiology Foundation