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.