Changes in Serum Potassium Levels During Hospitalization in Patients With Worsening Heart Failure and Reduced Ejection Fraction (from the EVEREST Trial)

Introduction: Hyper- and hypo-kalemia have each been associated with higher risk of death in in heart failure with reduced ejection fraction but the relationship between serum potassium and risk of death in heart failure with preserved ejection fraction (HFpEF) is not well established. We assessed the risk associated with high and low potassium in patients with HFpEF enrolled in the PARAGON-HF trial. Aim: To explore the association between serum potassium and mortality in patients with HFpEF and examine the interaction with renal function. Methods: Repeated events, Cox and mixed-effects models. The primary outcome in this analysis was death from any cause. Results: Patients: mean age 73 years, 52% female. Higher potassium was not associated with higher risk of death: adjusted time-updated HR (95%CI) for potassium >5.0 mmol/l =1.06 (0.85-1.32); p=0.61 (potassium 4-5 mmol/l referent HR=1.0). However, lower potassium was associated with higher risk of death: adjusted HR for potassium <4.0 mmol/l=1.51 (1.21-1.87); p<0.001. However, the risk related to potassium was modified by baseline renal function (p for interaction <0.05), whereby the excess mortality in patients with low potassium was most prominent in patients with an eGFR <60 ml/min/1.73m 2 (Figure). Conclusion: In adjusted analyses, low potassium was independently associated with mortality in patients with HFpEF, especially in the context of renal impairment.

Download Full-text

Economic burden of chronic heart failure with preserved vs. reduced ejection fraction - an analysis from the German Competence Network Heart Failure

Das Gesundheitswesen ◽

10.1055/s-0033-1354196 ◽

2013 ◽

Vol 75 (08/09) ◽

Cited By ~ 1

Author(s):

J Biermann ◽

T Neumann ◽

S Störk ◽

S Stauffenberg ◽

CE Angermann ◽

...

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Ejection Fraction ◽

Economic Burden ◽

Competence Network ◽

Reduced Ejection Fraction

Download Full-text

Heart Failure with Preserved Ejection Fraction – A Review

US Cardiology Review ◽

10.15420/usc.2012.9.2.90 ◽

2012 ◽

Vol 9 (1) ◽

pp. 90-95 ◽

Cited By ~ 1

Author(s):

Otto A Smiseth ◽

Anders Opdahl ◽

Espen Boe ◽

Helge Skulstad

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Diastolic Heart Failure ◽

The Elderly ◽

Left Ventricular ◽

Filling Pressure ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Reduced Ejection Fraction ◽

Objective Evidence

Heart failure with preserved left ventricular ejection fraction (HF-PEF), sometimes named diastolic heart failure, is a common condition most frequently seen in the elderly and is associated with arterial hypertension and left ventricular (LV) hypertrophy. Symptoms are attributed to a stiff left ventricle with compensatory elevation of filling pressure and reduced ability to increase stroke volume by the Frank-Starling mechanism. LV interaction with stiff arteries aggravates these problems. Prognosis is almost as severe as for heart failure with reduced ejection fraction (HF-REF), in part reflecting co-morbidities. Before the diagnosis of HF-PEF is made, non-cardiac etiologies must be excluded. Due to the non-specific nature of heart failure symptoms, it is essential to search for objective evidence of diastolic dysfunction which, in the absence of invasive data, is done by echocardiography and demonstration of signs of elevated LV filling pressure, impaired LV relaxation, or increased LV diastolic stiffness. Antihypertensive treatment can effectively prevent HF-PEF. Treatment of HF-PEF is symptomatic, with similar drugs as in HF-REF.

Download Full-text

Evaluation of the Efficacy of ST2 and NT-proBNP in the Diagnosis and Prediction of Short- Term Prognosis in Heart Failure with Reduced Ejection Fraction

International Journal of Pharmaceutical and Clinical Research ◽

10.25258/ijpcr.v9i04.8539 ◽

2017 ◽

Vol 9 (04) ◽

Author(s):

Shivananda B Nayak ◽

Dharindra Sawh ◽

Brandon Scott ◽

Vestra Sears ◽

Kareshma Seebalack ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Cardiac Biomarkers ◽

Double Blind Study ◽

Short Term ◽

Double Blind ◽

Reduced Ejection Fraction ◽

The Mean ◽

Design And Methods ◽

The Relationship

Purpose: i) To determine the relationship between the cardiac biomarkers ST2 and NT-proBNP with ejection fraction (EF) in heart failure (HF) patients. ii) Assess whether a superiority existed between the aforementioned cardiac markers in diagnosing the HF with reduced EF. iii) Determine the efficacy of both biomarkers in predicting a 30-day cardiovascular event and rehospitalization in patients with HF with reduced EF iv) To assess the influence of age, gender, BMI, anaemia and renal failure on the ST2 and NT-proBNP levels. Design and Methods: A prospective double-blind study was conducted to obtain data from a sample of 64 cardiology patients. A blood sample was collected to test for ST2 and NT-proBNP. An echocardiogram (to obtain EF value), electrocardiogram and questionnaire were also obtained. Results: Of the 64 patients enrolled, 59.4% of the population had an EF less than 40%. At the end of the 30- day period, 7 patients were warded, 37 were not warded, one died and 17 were non respondent. Both biomarkers were efficacious at diagnosing HF with a reduced EF. However, neither of them were efficacious in predicting 30-day rehospitalization. The mean NT-proBNP values being: not rehospitalized (2114.7486) and 30 day rehospitalization (1008.42860) and the mean ST2 values being: not rehospitalized (336.1975), and 30-day rehospitalization. (281.9657). Conclusion: Neither ST2 or NT-proBNP was efficacious in predicting the short- term prognosis in HF with reduced EF. Both however were successful at confirming the diagnosis of HF in HF patients with reduced EF.

Download Full-text