Prevalence, Incidence, and Outcomes of Hyperkalaemia in Patients with Chronic Heart Failure and Reduced Ejection Fraction from a Spanish Multicentre Study: SPANIK-HF Design and Baseline Characteristics
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Definition of the Study Population and Selection Criteria
2.3. Inclusion Criteria
2.4. Exclusion Criteria
2.5. Main Outcome Variables
2.6. Definition of Hyperkalaemia
2.7. Considerations about Sample Size
2.8. Data Collection
2.9. Data Management
3. Results
3.1. Baseline Patient Characteristics
3.2. Medication at the Time of Inclusion at the Baseline Visit
3.3. Distribution of K+ Values at the Baseline Visit
3.4. Interference of Hyperkalaemia in the Optimisation of Medical Treatment
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Conflicts of Interest
References
- Sicras-Mainar, A.; Sicras-Navarro, A.; Palacios, B.; Varela, L.; Delgado, J.F. Epidemiology and Treatment of Heart Failure in Spain: The HF-PATHWAYS Study. Rev. Esp. Cardiol. 2020, 75, 31–38. Available online: https://www.ncbi.nlm.nih.gov/pubmed/33380382 (accessed on 20 February 2022). [CrossRef] [PubMed]
- Sayago-Silva, I.; García-López, F.; Segovia-Cubero, J. Epidemiología de la insuficiencia cardiaca en España en los últimos 20 años. Rev. Esp. Cardiol. 2013, 66, 649–656. [Google Scholar] [CrossRef] [PubMed]
- McDonagh, T.A.; Metra, M.; Adamo, M.; Gardner, R.S.; Baumbach, A.; Böhm, M.; Burri, H.; Butler, J.; Čelutkienė, J.; Chioncel, O.; et al. 2021 ESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure. Eur. Heart J. 2021, 42, 3599–3726. Available online: https://www.ncbi.nlm.nih.gov/pubmed/34447992 (accessed on 20 February 2022). [CrossRef] [PubMed]
- Ferreira, J.P.; Butler, J.; Rossignol, P.; Pitt, B.; Anker, S.D.; Kosiborod, M.; Lund, L.H.; Bakris, G.L.; Weir, M.R.; Zannad, F. Abnormalities of Potassium in Heart Failure. J. Am. Coll. Cardiol. 2020, 75, 2836–2850. Available online: https://www.ncbi.nlm.nih.gov/pubmed/32498812 (accessed on 20 February 2022). [CrossRef] [PubMed]
- Sarwar, C.M.; Papadimitriou, L.; Pitt, B.; Piña, I.; Zannad, F.; Anker, S.D.; Gheorghiade, M.; Butler, J. Hyperkalemia in Heart Failure. J. Am. Coll. Cardiol. 2016, 68, 1575–1589. Available online: https://www.ncbi.nlm.nih.gov/pubmed/27687200 (accessed on 20 February 2022). [CrossRef] [PubMed]
- Perez, P.C.; González-Juanatey, J.R.; Nuche, J.; Fernández, L.M.; Pablos, D.L.; Alvarez-García, J.; Claret, R.B.; Selles, M.M.; García, R.V.; Dolz, L.M.; et al. Serum Potassium Dynamics during Acute Heart Failure Hospitalization. Clin. Res. Cardiol. 2020, 1–12. Available online: https://www.ncbi.nlm.nih.gov/pubmed/33070219 (accessed on 20 February 2022). [CrossRef]
- Linde, C.; Qin, L.; Bakhai, A.; Furuland, H.; Evans, M.; Ayoubkhani, D.; Palaka, E.; Bennett, H.; McEwan, P. Serum Potassium and Clinical Outcomes in Heart Failure Patients: Results of Risk Calculations In 21,334 Patients in the UK. ESC Heart Failure 2019, 6, 280–290. Available online: https://www.ncbi.nlm.nih.gov/pubmed/30629342 (accessed on 20 February 2022). [CrossRef] [PubMed]
- Ferreira, J.P.; Mogensen, U.M.; Jhund, P.S.; Desai, A.S.; Rouleau, J.; Zile, M.R.; Rossignol, P.; Zannad, F.; Packer, M.; Solomon, S.D.; et al. Serum potassium in the PARADIGM-HF trial. Eur. J. Heart Fail. 2020, 22, 2056–2064. Available online: https://www.ncbi.nlm.nih.gov/pubmed/32809261 (accessed on 20 February 2022). [CrossRef] [PubMed]
- Núñez, J.; Bayés-Genís, A.; Zannad, F.; Rossignol, P.; Núñez, E.; Bodí, V.; Miñana, G.; Santas, E.; Chorro, F.J.; Mollar, A.; et al. Long-Term Potassium Monitoring and Dynamics in Heart Failure and Risk of Mortality. Circulation 2018, 137, 1320–1330. Available online: https://www.ncbi.nlm.nih.gov/pubmed/29025765 (accessed on 20 February 2022). [CrossRef] [PubMed]
- Jiménez-Marrero, S.; Cainzos-Achirica, M.; Monterde, D.; Vela, E.; Cleries, M.; García-Eroles, L.; Enjuanes, C.; Yun, S.; Garay, A.; Moliner, P.; et al. Impacto clínico y en costes sanitarios de alteraciones de potasio en pacientes con enfermedades cardiovasculares, metabólicas y renales crónicas. Rev. Esp. Cardiol. 2021, 74, 312–320. [Google Scholar] [CrossRef] [PubMed]
- Sánchez, M.A.; Rodríguez, J.L.L.; Freire, R.B.; Colet, J.C.; Leiro, M.G.C.; Vílchez, F.G.; Lorite, N.M.; Cubero, J.S.; Mateas, F.R.; Somoza, F.J.E.; et al. Classification and Quality Standards of Heart Failure Units: Scientific Consensus of the Spanish Society of Cardiology. Rev. Esp. Cardiol. 2016, 69, 940–950. Available online: https://www.ncbi.nlm.nih.gov/pubmed/27576081 (accessed on 20 February 2022). [CrossRef]
- Crespo-Leiro, M.G.; Barge-Caballero, E.; Segovia-Cubero, J.; González-Costello, J.; López-Fernández, S.; García-Pinilla, J.M.; Almenar-Bonet, L.; de Juan-Bagudá, J.; Roig-Minguell, E.; Bayes-Genis, A.; et al. Hyperkalemia in Heart Failure Patients in Spain and its Impact on Guidelines and Recommendations: ESC-EORP-HFA Heart Failure Long-Term Registry. Rev. Esp. Cardiol. 2020, 73, 313–323. Available online: https://www.ncbi.nlm.nih.gov/pubmed/31672562 (accessed on 20 February 2022). [CrossRef] [PubMed]
- McMurray, J.J.V.; Packer, M.; Desai, A.S.; Gong, J.; Lefkowitz, M.; Rizkala, A.R.; Rouleau, J.L.; Shi, V.C.; Solomon, S.D.; Swedberg, K.; et al. Baseline Characteristics and Treatment of Patients in Prospective Comparison of ARNI with ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure Trial (PARADIGM-HF). Eur. J. Heart Fail. 2014, 16, 817–825. Available online: https://www.ncbi.nlm.nih.gov/pubmed/24828035 (accessed on 20 February 2022). [CrossRef] [PubMed] [Green Version]
- Sicras-Mainar, A.; Sicras-Navarro, A.; Palacios, B.; Varela, L.; Delgado, J.F. Epidemiología y tratamiento de la insuficiencia cardiaca en España: Estudio PATHWAYS-HF. Rev. Esp. Cardiol. 2020, 75, 31–38. [Google Scholar] [CrossRef] [PubMed]
- Greene, S.J.; Butler, J.; Albert, N.M.; DeVore, A.D.; Sharma, P.P.; Duffy, C.I.; Hill, C.L.; McCague, K.; Mi, X.; Patterson, J.H.; et al. Medical Therapy for Heart Failure with Reduced Ejection Fraction. J. Am. Coll. Cardiol. 2018, 72, 351–366. Available online: https://www.ncbi.nlm.nih.gov/pubmed/30025570 (accessed on 20 February 2022). [CrossRef] [PubMed]
- Linssen, G.C.M.; CHECK-HF Investigators; Veenis, J.; Rocca, H.P.B.-L.; Van Pol, P.E.J.; Engelen, D.J.M.; Van Tooren, R.M.; Koornstra-Wortel, H.J.J.; Hoes, A.W.; Brugts, J.J. Differences in Guideline-Recommended Heart Failure Medication between Dutch Heart Failure Clinics: An Analysis of the CHECK-HF Registry. Neth. Heart J. 2020, 28, 334–344. Available online: https://www.ncbi.nlm.nih.gov/pubmed/32430655 (accessed on 20 February 2022). [CrossRef] [PubMed]
- Ponikowski, P.; Voors, A.A.; Anker, S.D.; Bueno, H.; Cleland, J.G.F.; Coats, A.J.S.; Falk, V.; González-Juanatey, J.R.; Harjola, V.-P.; Jankowska, E.A.; et al. 2016 ESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure of the European Society of Cardiology (ESC) Developed with the Special Contribution of the Heart Failure Association (HFA) of the ESC. Eur. Heart. J. 2016, 37, 2129–2200, Erratum in Eur. Heart. J. 2018, 39, 860. Available online: https://pubmed.ncbi.nlm.nih.gov/27206819/ (accessed on 20 February 2022). [CrossRef]
- Jain, N.; Kotla, S.; Little, B.B.; Weideman, R.A.; Brilakis, E.; Reilly, R.F.; Banerjee, S. Predictors of Hyperkalemia and Death in Patients with Cardiac and Renal Disease. Am. J. Cardiol. 2012, 109, 1510–1513. Available online: https://www.ncbi.nlm.nih.gov/pubmed/22342847 (accessed on 20 February 2022). [CrossRef] [PubMed]
- Ko, D.T.; Juurlink, D.N.; Mamdani, M.M.; You, J.J.; Wang, J.T.; Donovan, L.R.; Tu, J.V. Appropriateness of Spironolactone Prescribing in Heart Failure Patients: A Population-Based Study. J. Card. Fail. 2006, 12, 205–210. Available online: https://www.ncbi.nlm.nih.gov/pubmed/16624686 (accessed on 20 February 2022). [CrossRef] [PubMed]
- Trevisan, M.; De Deco, P.; Xu, H.; Evans, M.; Lindholm, B.; Bellocco, R.; Barany, P.; Jernberg, T.; Lund, L.H.; Carrero, J.J. Incidence, Predictors and Clinical Management of Hyperkalaemia in New Users of Mineralocorticoid Receptor Antagonists. Eur. J. Heart Fail. 2018, 20, 1217–1226. Available online: https://www.ncbi.nlm.nih.gov/pubmed/29667759 (accessed on 20 February 2022). [CrossRef] [PubMed] [Green Version]
Patient Characteristic | Value |
---|---|
Age ([mean (SD)] in years) | 65.9 (12.3) |
<60 years | 27.4 |
60–69 years | 30.8 |
70–79 years | 28.5 |
≥80 years | 13.3 |
Male | 78.2 |
Ischemic aetiology | 45.3 |
Body mass index (n = 565; [mean (SD)] in kg/m2) | 28.6 (4.8) |
Heart rate ([mean (SD)] in bpm) | 68.2 (12) |
Systolic blood pressure ([mean (SD)] in mmHg) | 115.0 (17.9) |
Diastolic blood pressure ([mean (SD)] in mmHg) | 69.1 (10.4) |
Atrial fibrillation | 38.8 |
Diabetes mellitus | 43.4 |
Stroke or transient ischemic attack | 9.7 |
Chronic obstructive pulmonary disease | 12.9 |
Chronic kidney disease | 26.4 |
Cancer | 5.8 |
Depression | 10.4 |
Left ventricular ejection fraction [mean (SD)] | 30.7 (7.3) |
Glomerular filtration rate (MDRD) (n = 564; [mean (SD)] in ml/min/1.73 m2) | 67.6 (25.8) |
<30 mL/min/1.73 m2 | 5.3 |
30–59 mL/min/1.73 m2 | 36.2 |
≥60 mL/min/1.73 m2 | 58.5 |
Atrial peptides | |
BNP (n = 37; [mean (SD)] in pg/mL) | 466.76 ± 481.56 |
NT-proBNP (n = 490; [mean (SD)] in pg/mL) | 2474.1 (3963.6) |
Medication | % |
---|---|
Diuretics | 76.3 |
Ivabradine | 12.9 |
Digital | 7.1 |
Statins | 70.8 |
SGLT2i | 18.1 |
Antiplatelet | 40.0 |
Anticoagulants | 48.5 |
Amiodarone | 11.7 |
Nitrates | 6.2 |
Total (n) | Mean (SD) | IC95 (%) | ||
---|---|---|---|---|
K+ | 565 | 4.6 (0.52) | ||
Distribution of K+ | % | |||
≤5 mEq/L | 455 | 80.5 | 77.0 | 83.7 |
5.1–5.4 mEq/L | 78 | 13.8 | 11.1 | 16.9 |
5.5–5.9 mEq/L | 26 | 4.6 | 3.0 | 6.7 |
≥6 mEq/L | 6 | 1.1 | 0.39 | 2.3 |
Hypokalaemia (<3.5 mEq/L) | 12 | 2.1 | 1.1 | 3.7 |
Drugs | Number of Patients Receiving Treatment [n (%)] | Hyperkalaemia as a Cause of Contraindication or Intolerance [n/Number of Patients with Contraindication or Who Did Not Tolerate the Drug (%)] | Patients Not Reaching Target Dose [n/Number Patients Receiving Drug (%)] | Hyperkalaemia as a Cause of Not Reaching Target Dose [n/Number of Patients Who Do Not Reach the Target Dose (%)] |
---|---|---|---|---|
ACEi | 107 (18.9) | 3/72 (4.2) | 67/107 (62.6) | 2/67 (3.0) |
ARBs | 64 (11.3) | 2/83 (2.4) | 46/64 (71.9) | 2/46 (4.3) |
MRAs | 441 (78.5) | 24/69 (34.8) | 311/441 (70.5) | 39/311 (12.5) |
ARNi | 361 (63.8) | 3/65 (4.6) | 225/361 (62.3) | 13/225 (5.8) |
BBs | 525 (92.9) | N.A. | 335/525 (63.8) | N.A. |
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Delgado-Jiménez, J.F.; Segovia-Cubero, J.; Almenar-Bonet, L.; de Juan-Bagudá, J.; Lara-Padrón, A.; García-Pinilla, J.M.; Bonilla-Palomas, J.L.; López-Fernández, S.; Mirabet-Pérez, S.; Gómez-Otero, I.; et al. Prevalence, Incidence, and Outcomes of Hyperkalaemia in Patients with Chronic Heart Failure and Reduced Ejection Fraction from a Spanish Multicentre Study: SPANIK-HF Design and Baseline Characteristics. J. Clin. Med. 2022, 11, 1170. https://doi.org/10.3390/jcm11051170
Delgado-Jiménez JF, Segovia-Cubero J, Almenar-Bonet L, de Juan-Bagudá J, Lara-Padrón A, García-Pinilla JM, Bonilla-Palomas JL, López-Fernández S, Mirabet-Pérez S, Gómez-Otero I, et al. Prevalence, Incidence, and Outcomes of Hyperkalaemia in Patients with Chronic Heart Failure and Reduced Ejection Fraction from a Spanish Multicentre Study: SPANIK-HF Design and Baseline Characteristics. Journal of Clinical Medicine. 2022; 11(5):1170. https://doi.org/10.3390/jcm11051170
Chicago/Turabian StyleDelgado-Jiménez, Juan F., Javier Segovia-Cubero, Luis Almenar-Bonet, Javier de Juan-Bagudá, Antonio Lara-Padrón, José Manuel García-Pinilla, Juan Luis Bonilla-Palomas, Silvia López-Fernández, Sonia Mirabet-Pérez, Inés Gómez-Otero, and et al. 2022. "Prevalence, Incidence, and Outcomes of Hyperkalaemia in Patients with Chronic Heart Failure and Reduced Ejection Fraction from a Spanish Multicentre Study: SPANIK-HF Design and Baseline Characteristics" Journal of Clinical Medicine 11, no. 5: 1170. https://doi.org/10.3390/jcm11051170
APA StyleDelgado-Jiménez, J. F., Segovia-Cubero, J., Almenar-Bonet, L., de Juan-Bagudá, J., Lara-Padrón, A., García-Pinilla, J. M., Bonilla-Palomas, J. L., López-Fernández, S., Mirabet-Pérez, S., Gómez-Otero, I., Castro-Fernández, A., Díaz-Molina, B., Goirigolzarri-Artaza, J., Rincón-Díaz, L. M., Pascual-Figal, D. A., Anguita-Sánchez, M., Muñiz, J., & Crespo-Leiro, M. G. (2022). Prevalence, Incidence, and Outcomes of Hyperkalaemia in Patients with Chronic Heart Failure and Reduced Ejection Fraction from a Spanish Multicentre Study: SPANIK-HF Design and Baseline Characteristics. Journal of Clinical Medicine, 11(5), 1170. https://doi.org/10.3390/jcm11051170