Clinical Trial Finds Administering Potassium at 3.6 mEq/L as Effective as Standard 4.5 mEq/L Threshold Post Cardiac Surgery - Video

A new study has shown that a lower threshold for potassium supplementation after cardiac surgery saves patient costs and does not create any further risks of atrial fibrillation or other dysrhythmias.

It’s common practice for patients to receive intravenous potassium supplementation after any form of heart surgery if their potassium levels drop below 4.5 mEq/L (Milliequivalents per litre). However, a new clinical trial whose results are published in

JAMA, suggests that potassium supplementation only at levels below 3.6 mEq/L is non-inferior to standard practice as a way to lower the risk of atrial fibrillation (AFib) after surgery.

The risk of AFib increases with age, but it can sometimes occur among young people. People with AFib may have a much faster heart rate than usual, and the heart does not pump blood around the body efficiently. Blood may collect or pool in the heart, increasing the likelihood of clots.

it is the most frequent postoperative adverse event, and according to the authors of the new study, it can lead to expensive hospital bills, longer hospital stays, and a higher risk of death.

Researchers conducted a randomized clinical trial at 23 cardiac surgical centers utilizing 1,690 patients with no history of atrial dysrhythmias who were scheduled for isolated coronary artery bypass grafting surgery.

Of those, 843 were in the group with the “relaxed” standard for supplementation. The lowered threshold for potassium supplementation did not result in any further adverse developments or increased heart dysrhythmias, and the cost savings per patient in the “relaxed” group had a mean difference of $111.89.

Reference: O’Brien B, Campbell NG, Allen E, et al. Potassium Supplementation and Prevention of Atrial Fibrillation After Cardiac Surgery: The TIGHT K Randomized Clinical Trial. JAMA. Published online August 31, 2024. doi:10.1001/jama.2024.17888