Association of Potassium Level at Discharge with Long-Term Mortality in Hospitalized Patients with Heart Failure
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Population and Protocol
2.2. Data Collection
2.3. Variable Definitions
2.4. Study Endpoints
2.5. Statistical Analysis
3. Results
3.1. Patients Characteristics
3.2. Association of Potassium with 2-Year Mortality
3.3. Prescription Rate and Impact of Combination Medical Therapy
4. Discussion
4.1. Differential Impact of Hypokalemia and Hyperkalemia on Prognosis
4.2. Patient Characteristics and Therapeutic Targets of Hypokalemia
4.3. Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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All (n = 3398) | Hypokalemia (n = 115) | Normokalemia (n = 2960) | Hyperkalemia (n = 323) | p Value | |
---|---|---|---|---|---|
Age, years | 74 ± 13 | 77 ± 13 | 74 ± 13 | 75 ± 12 | 0.015 |
Female, n (%) | 1360 (40) | 58 (50) | 1191 (40) | 111 (34) | 0.008 |
Hypertension, n (%) | 2225 (65) | 76 (66) | 1928 (65) | 221 (68) | 0.501 |
Dyslipidemia, n (%) | 1294 (38) | 41 (36) | 1127 (38) | 126 (39) | 0.819 |
Diabetes Mellitus, n (%) | 1128 (33) | 33 (29) | 969 (33) | 126 (39) | 0.047 |
History of HF, n (%) | 999 (29) | 54 (47) | 852 (29) | 93 (29) | <0.001 |
COPD, n (%) | 163 (5) | 4 (3) | 141 (5) | 18 (6) | 0.716 |
Stroke, n (%) | 446 (13) | 18 (16) | 386 (13) | 42 (13) | 0.656 |
LVEF, % | 45 ± 15 | 47 ± 14 | 45 ± 15 | 44 ± 15 | 0.174 |
LVEF <40%, n (%) | 1344 (40) | 34 (30) | 1175 (40) | 134 (41) | 0.059 |
Etiologies of heart failure | |||||
IHD, n (%) | 971 (29) | 26 (23) | 843 (28) | 102 (32) | 0.183 |
DCM, n (%) | 486 (14) | 7 (6) | 430 (15) | 49 (15) | 0.025 |
VHD, n (%) | 889 (26) | 39 (34) | 778 (26) | 72 (22) | 0.049 |
Others, n (%) | 1052 (31) | 43 (37) | 909 (31) | 100 (31) | 0.314 |
AF/AFL, n (%) | 1706 (50) | 62 (54) | 1501 (51) | 143 (44) | 0.189 |
Pacemaker, n (%) | 264 (8) | 13 (11) | 231 (8) | 20 (6) | 0.217 |
ICD, n (%) | 124 (4) | 8 (7) | 103 (3) | 13 (4) | 0.137 |
CRT, n (%) | 58 (2) | 4 (3) | 47 (2) | 7 (2) | 0.166 |
Status at discharge | |||||
Body mass index, kg/m2 | 22 ± 4 | 21 ± 4 | 22 ± 4 | 21 ± 4 | 0.005 |
Systolic blood pressure, mmHg | 112 ± 17 | 116 ± 19 | 112 ± 17 | 111 ± 18 | 0.019 |
Diastolic blood pressure, mmHg | 62 ± 11 | 63 ± 13 | 61 ± 11 | 62 ± 12 | 0.345 |
Heart rate, bpm | 71 ± 13 | 73 ± 14 | 71 ± 12 | 71 ± 13 | 0.122 |
NYHA III/IV, n (%) | 701 (21) | 38 (33) | 589 (20) | 74 (23) | 0.002 |
Cachexia, n (%) | 759 (22) | 38 (33) | 645 (22) | 76 (24) | 0.012 |
Laboratory data at discharge | |||||
Hemoglobin, g/dL | 12.2 ± 2.2 | 11.5 ± 2.0 | 12.2 ± 2.1 | 12.2 ± 2.4 | 0.003 |
eGFR, mL/min/1.73 m2 | 51.0 (36.2–64.6) | 55.4 (35.9–67.1) | 51.8 (37.4–65.5) | 40.5 (28.8–55.0) | <0.001 |
Albumin, g/dL | 3.5 ± 0.5 | 3.3 ± 0.5 | 3.5 ± 0.5 | 3.5 ± 0.5 | <0.001 |
Sodium, mEq/L | 139 ± 4 | 140 ± 4 | 139 ± 3 | 137 ± 4 | <0.001 |
Potassium, mEq/L | 4.3 ± 0.5 | 3.2 ± 0.2 | 4.3 ± 0.4 | 5.3 ± 0.4 | <0.001 |
Medication at discharge | |||||
Combination medical therapy, n (%) | 1740 (51) | 46 (40) | 1522 (51) | 172 (53) | 0.041 |
RAS-I, n (%) | 2170 (64) | 63 (55) | 1891 (64) | 216 (67) | 0.069 |
Beta-blockers, n (%) | 2609 (77) | 78 (68) | 2275 (77) | 256 (79) | 0.042 |
MRA, n (%) | 1213 (36) | 42 (37) | 1076 (36) | 95 (29) | 0.042 |
Loop diuretics, n (%) | 2621 (77) | 90 (78) | 2296 (78) | 235 (73) | 0.136 |
Furosemide equivalent dose, mg | 20 (20–40) | 40 (20–40) | 20 (20–40) | 20 (20–40) | <0.001 |
High-dose loop diuretics, n (%) | 276 (8) | 19 (17) | 239 (8) | 18 (6) | 0.004 |
Thiazide diuretics, n (%) | 244 (7) | 18 (16) | 210 (7) | 16 (5) | 0.002 |
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Miura, Y.; Higuchi, S.; Kohno, T.; Shiraishi, Y.; Kitamura, M.; Nagatomo, Y.; Takei, M.; Nakano, S.; Goda, A.; Soejima, K.; et al. Association of Potassium Level at Discharge with Long-Term Mortality in Hospitalized Patients with Heart Failure. J. Clin. Med. 2022, 11, 7358. https://doi.org/10.3390/jcm11247358
Miura Y, Higuchi S, Kohno T, Shiraishi Y, Kitamura M, Nagatomo Y, Takei M, Nakano S, Goda A, Soejima K, et al. Association of Potassium Level at Discharge with Long-Term Mortality in Hospitalized Patients with Heart Failure. Journal of Clinical Medicine. 2022; 11(24):7358. https://doi.org/10.3390/jcm11247358
Chicago/Turabian StyleMiura, Yusuke, Satoshi Higuchi, Takashi Kohno, Yasuyuki Shiraishi, Mitsunobu Kitamura, Yuji Nagatomo, Makoto Takei, Shintaro Nakano, Ayumi Goda, Kyoko Soejima, and et al. 2022. "Association of Potassium Level at Discharge with Long-Term Mortality in Hospitalized Patients with Heart Failure" Journal of Clinical Medicine 11, no. 24: 7358. https://doi.org/10.3390/jcm11247358