Hyperkalemia independent risk factor for Heart Failure with mildly reduced Ejection Fraction, suggests study

There is a global increasing
prevalence of heart failure, and it is associated with increased mortality and rehospitalization.
Dyskalemia disrupts potassium homeostasis by increasing arrhythmia and an
increased mortality rate. Even though dyskalemia leads to a common complication
in patients with heart failure (HF) and reduced left ventricular ejection
fraction (LVEF), data concerning the prevalence and prognostic impact of
dyskalemias in HFmrEF is limited. Hence, researchers conducted a study to investigate
the prognostic impact of dyskalemia in patients hospitalized with HFmrEF.

A retrospective study was carried
out from a single-center all-comers registry by including consecutive patients
with HFmrEF from 2016 to 2022. By comparing patients with potassium
levels > 3.3 to ≤4.5 mmol/L, ≤3.3 mmol/L,
and > 4.5 mmol/L, the prognostic impact of potassium levels
was assessed. The primary endpoint was all-cause mortality at 30 days.

Findings:

• About 2079 patients with HFmrEF and potassium
  measurement were included in the study.
• The median potassium level was 4.4 mmol/L
  with a mean of 4.2 mmol/L.
• Among the total patients hospitalized with
  HFmrEF, 84 % presented with potassium levels in the normal range, 8 %
  with hypokalemia, and 8 % with hyperkalemia, respectively.
• Hyperkalemia was associated with an increased
  risk of all-cause mortality at 30 days when compared to patients with
  normokalemia (7 % vs 4 %; log-rank p = 0.026).
• The presence of hypokalemia (6 %; log-rank p = 0.075)
  was not significantly associated with the risk of 30-day all-cause mortality.
• Compared to patients with normokalemia, the
  presence of hyperkalemia was still associated with an increased risk of 30-day
  all-cause mortality within a multivariable Cox regression analysis
  (HR = 2.002; 95 % CI 1.004–3.992; p = 0.049).

Thus, the researchers concluded
that Hyperkalemia doubled the 30-day all-cause mortality risk, while
hypokalemia showed no increased risk. Even though both hypo and hyperkalemia
were present with HFmrEF, hyperkalemia was more associated with an increased
risk of all-cause mortality at 30 days.

The study underscores the
importance of monitoring and managing hyperkalemia in hospitalized patients
with HFmrEF. As hyperkalemia is an independent risk factor for heart failure,
interventions should be carried out to improve outcomes in heart failure
patients.

Further reading: Marielen Reinhardt
et al. Potassium levels and short-term outcomes in heart failure with mildly
reduced ejection fraction. Doi: 10.1016/j.ijcard.2024.132878.