Photo Credit: Pornpak Khunatorn

The following is a summary of “Hyperkalemia in acute heart failure: Short term outcomes from the EAHFE registry,” published in the August 2023 issue of Emergency Medicine by Rafique et al.

Both hyperkalemia (HK) and acute heart failure (AHF) are correlated with heightened short-term mortality, and the treatment of either condition may worsen the other. Given the inadequate description of the association between HK and AHF, researcher’s objective was to assess the correlation between HK and short-term outcomes in patients with Acute Heart Failure (AHF) presenting to the Emergency Department (ED). The EAHFE Registry registers all patients with ED AHF (Emergency Department Acute Heart Failure) from 45 Spanish EDs (Emergency Departments) and documents the outcomes during and after discharge. The primary result of the researcher’s study was the occurrence of all-cause in-hospital mortality. In contrast, the secondary outcomes included prolonged hospitalization (more than 7 days) and adverse events within 7 days after discharge, such as revisiting the emergency department, hospitalization, or mortality. 

The study investigated the relationship between serum potassium (sK) levels and medical outcomes through logistic regression and restricted cubic spline (RCS) curves. The reference point for sK was set at 4.0 mEq/L. The analysis was adjusted for age, sex, comorbidities, patient baseline status, and chronic treatments. Interaction analyses were conducted for the primary outcome measure. Among a total of 13,606 patients admitted to the emergency department with acute heart failure (AHF), the median age (interquartile range) was 83 years (76–88), with 54% being female. The median serum potassium (interquartile content) was 4.5 mEq/L (4.3–4.9), ranging from 4.0 to 9.9 mEq/L. The in-hospital mortality rate was 7.7%, with a significant proportion of patients experiencing prolonged hospitalization at 35.9%. 

Additionally, an 8.7% rate of adverse events occurred within 7 days after discharge. The in-hospital mortality rate showed a consistent increase from sK ≥4.8 (OR = 1.35, 95% CI = 1.01–1.80) to sK = 9.9 (OR = 8.41, 95% CI = 3.60–19.6). Individuals without diabetes with elevated serum potassium levels had a greater likelihood of mortality, whereas using mineralocorticoid-receptor antagonists for long-term management showed varying outcomes. Neither extended hospitalization nor adverse events after discharge were found to be associated with serum potassium levels. In the emergency department, acute heart failure, an initial serum potassium level greater than 4.8 milliequivalents per liter was found to be independently linked to mortality during the hospital stay. This suggests that individuals in this group may benefit from intensive treatment to correct their high potassium levels.

Source: sciencedirect.com/science/article/abs/pii/S0735675723002486