SPC365

Hyperkalemia and Heart Failure with reduced ejection fraction: Prevalence and prognostic impact on a Portuguese population

Session: Posters (Sessão 5 - Écran 4) - Insuficiência Cardíaca 5 - Marcadores Serológicos
Speaker: Marta Azevedo Ferreira

Congress: CPC 2022
Topic: D. Heart Failure
Theme: 10. Chronic Heart Failure
Subtheme: 10.2 Chronic Heart Failure – Epidemiology, Prognosis, Outcome
Session Type: Pósters Electrónicos
FP Number: ---
Authors: Marta Azevedo Ferreira; Sara Gonçalves; Tatiana Duarte; Ana Sousa; Crisálida Ferreira; Joana Ferreira; Joana Simões; Rui Caria

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="background-color:white"><span style="color:black">Introduction:</span></span></strong><span style="background-color:white"><span style="color:black"> Hyperkalemia (hyperK) is a frequent complication in patients (pts) with heart failure (HF). This complication leads to discontinuation or reduction of disease modifying therapy (DMT) exposing the pts to a higher cardiovascular risk.&nbsp;However, data regarding prevalence and clinical impact of hyperK in Portuguese pts with heart failure with reduced ejection fraction (HFrEF) are scarce.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="background-color:white"><span style="color:black">Aim:</span></span></strong><span style="background-color:white"><span style="color:black"> To evaluate the prevalence and prognostic impact of hyperK in pts with HFrEF.</span></span></span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="background-color:white"><span style="color:black">Methods:</span></span></strong><span style="background-color:white"><span style="color:black"> We evaluated 103 consecutive pts with HFrEF admitted in a Heart Failure clinic in 2019. The population was characterized according to baseline and therapeutic characteristics. The prevalence of hyperK - defined as serum potassium (K+) &gt; 5.0mEq/L - was determined. The population was divided in two groups according to the presence or absence of hyperK. The groups were compared regarding basal characteristics. The need to reduction/discontinuation of DMT was determined. The impact of hiperK on the risk of HF hospitalization and mortality at 1 year was evaluated.</span></span> Pts with a follow up &lt; 3 months were excluded. Mean follow up was 18+-3 months.</span></span></p>

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<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="background-color:white"><span style="color:black">Results:</span></span></strong><span style="background-color:white"><span style="color:black"> We studied 103 pts (76,7% male, mean age 65,2 years &plusmn; 11,5). Mean left ventricular ejection fraction (LVEF) was 29,9+-8,8% , 57% (n=59) had ischemic etiology , 88,3% (n=91) had hypertension; 37,9% (n= 39) had Diabetes Mellitus (DM) and 63% (n= 65) had chronic kidney disease (CKD), with a mean estimated glomerular filtration rate (eGFR) of 69,5ml/min/1.73m<sup>2</sup>. At the last follow-up pts were under angiotensin receptor neprilysin inhibitor (ARNI) in 64,1% (n=66) , mineralocorticoid receptor antagonist (MRA) in 70.9% (n=73), angiotensin converting enzyme inhibitors (ACEi)/</span></span>a<span style="background-color:white"><span style="color:black">ngiotensin receptor blockers (ARBs) in 30,1% (n=31), sodium-glucose cotransporter 2 inhibitors (SGLT2i) in 63,1% (n= 65) and &beta;-blockers in 96,1% (n=99) of the cases. HyperK was present in 61,2% (n=63) of the pts. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="background-color:white"><span style="color:black">Pts with hyperK were older (62&plusmn;11 vs 67&plusmn;11years, p=0,047) and had lower eGFR (74ml/min/1.72m2 vs 52ml/min/1.72m2, p&lt;0,001). MRA were reduced in 10% (n=6) of the pts and suspended in 23% (n=14). ARNI were reduced in 1,6% (n=1) of the hiperK pts and suspended in 5% (n=3) and ACEi/ARA were suspended in 3% (n=2). HyperK &gt;5,5 mEq/L (n=33) was associated with higher rates of hospitalization (27,7% vs 11,4% p=0,043). Nevertheless, in multivariate analysis hiperK was not an independent predictor of HF hospitalization or mortality.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="background-color:white"><span style="color:black">Conclusion:</span></span></strong><span style="background-color:white"><span style="color:black"> HyperK is frequent in pts with HF and limits the use of drugs with prognostic benefit. The prevalence of hyperK was high in this population. Although it frequently led to DMT reduction/suspension, hyperK was not associated with an independent increased risk of hospitalization or mortality in this population.</span></span></span></span></p>