scholarly journals Prognostic impact of polypharmacy by drug essentiality in patients on hemodialysis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Mineaki Kitamura ◽  
Kosei Yamaguchi ◽  
Yuki Ota ◽  
Satoko Notomi ◽  
Maya Komine ◽  
...  
Keyword(s):  
Relative Risk ◽  
Confidence Interval ◽  
Clinical Relevance ◽  
Patient Characteristics ◽  
Hazard Ratio ◽  
Essential Medicines ◽  
Prognostic Impact ◽  
All Cause Mortality ◽  
Prescribed Medicines

AbstractAlthough polypharmacy is common among patients on hemodialysis (HD), its association with prognosis remains unclear. This study aimed to elucidate the association between the number of prescribed medicines and all-cause mortality in patients on HD, accounting for essential medicines (i.e., antihypertensives, antidiabetic medicines, and statins) and non-essential medicines. We evaluated 339 patients who underwent maintenance HD at Nagasaki Renal Center between July 2011 and June 2012 and followed up until June 2021. After adjusting for patient characteristics, the number of regularly prescribed medicines (10.0 ± 4.0) was not correlated with prognosis (hazard ratio [HR]: 1.01, 95% confidence interval [CI] 0.97–1.05, p = 0.60). However, the number of non-essential medicines (7.9 ± 3.6) was correlated with prognosis (HR: 1.06, 95% CI 1.01–1.10, p = 0.009). Adjusting for patient characteristics, patients who were prescribed more than 10 non-essential medicines were found to have a significantly higher probability of mortality than those prescribed less than five non-essential medicines, with a relative risk of 2.01 (p = 0.004). In conclusion, polypharmacy of non-essential medicines increases the risk of all-cause mortality in patients on HD. As such, prescribing essential medicines should be prioritized, and the clinical relevance of each medicine should be reviewed by physicians and pharmacists.

scholarly journals Social frailty provides additive prognostic impact on one-year outcome in aged patients with congestive heart failure

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Jujo ◽  
N Kagiyama ◽  
K Kamiya ◽  
H Saito ◽  
K Saito ◽  
...  
Keyword(s):  
Heart Failure ◽  
Confidence Interval ◽  
Hazard Ratio ◽  
Rank Test ◽  
Funding Source ◽  
Prognostic Impact ◽  
Aged Patients ◽  
Patients With Heart Failure ◽  
All Cause Mortality ◽  
The Impact

Abstract Background Frailty is associated with multisystem declines in physiologic reserve and increased vulnerability to stressors, resulting in increased risks of adverse clinical outcomes in patients with heart failure (HF). Although frailty is conceptualized as an accumulation of deficits in multiple areas, most of the studies have focused mainly on physical frailty, and the social domains is one of the least investigated area. Objectives We prospectively evaluated the incidence and prognostic implication of social frailty (SF) in older patients with HF. Methods The FRAGILE-HF is a multicenter, prospective cohort study including patients hospitalized for HF and aged ≥65 years old. We defined SF by Makizako's 5 items, which are 5 questions proposed and validated to be associated with future disability. The primary endpoint of this study was a composite of death from any cause and rehospitalization due to HF. The impact of SF on all-cause mortality alone was also evaluated. Results Among 1,240 hospitalized HF patients, 5 simple questions revealed that 825 (66.5%) were in SF. During 1-year observation period after the discharge, the combined endpoint was observed in 399 (32.2%) patients, and 145 (11.7%) patients died. Kaplan-Meier analysis showed that SF patients had significantly higher rates of both the combined endpoint and all-cause mortality than those without SF (Log-rank test: p<0.05 for both, Figures). Moreover, SF remained independently associated with higher event rate of the combined endpoint (hazard ratio: 1.30; 95% confidence interval: 1.02 to 1.66; p=0.038) and all-cause mortality (hazard ratio: 1.53; 95% confidence interval: 1.01 to 2.30; p=0.044), even after adjusting for other covariates. Significant incremental prognostic value was shown when information on social frailty was added to known risk factors for combined endpoint (NRI: 0.189, 95% confidence interval: 0.063–0.316, p=0.003) and all-cause mortality (NRI: 0.234, 95% confidence interval: 0.073–0.395, p=0.004). Conclusions Among older hospitalized patients with heart failure, two-thirds of the population was with SF. Evaluating SF provides additive prognostic information in elderly patients with heart failure. Funding Acknowledgement Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): Novartis Pharma Research Grants, Japan Heart Foundation Research Grant

scholarly journals Prognostic impact of right bundle branch block in hospitalized patients with idiopathic dilated cardiomyopathy: a single-center cohort study

2018 ◽  
Vol 48 (1) ◽  
pp. 030006051880147 ◽  
Author(s):  
Li Lai ◽  
Rong Jiang ◽  
Wei Fang ◽  
Chao Yan ◽  
Yibin Tang ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Dilated Cardiomyopathy ◽  
Right Bundle Branch Block ◽  
Left Ventricular ◽  
Hazard Ratio ◽  
Hospitalized Patients ◽  
Idiopathic Dilated Cardiomyopathy ◽  
Prognostic Impact ◽  
Bundle Branch Block ◽  
All Cause Mortality

Objective Idiopathic dilated cardiomyopathy (IDCM) is a primary myocardial disease resulting in symptoms of heart failure. Right bundle branch block (RBBB) is associated with increased cardiovascular risk and all-cause mortality. Therefore, the present study was performed to identify the prognostic impact of RBBB in patients with IDCM. Methods In total, 165 hospitalized patients with IDCM were evaluated. Receiver operating characteristic curve analysis was used to determine the cutoff point, and Cox regression was used to assess risk factors. Results After a median follow-up of 73.1 months (interquartile range, 36.1–88.7 months), 59 (35.8%) patients had died. All-cause mortality was significantly higher in patients with than without RBBB (log-rank χ2 = 9.400), P<0.05. Significant independent predictors of all-cause mortality in patients with IDCM were RBBB (hazard ratio, 2.898; 95% confidence interval, 1.201–6.995) and the left ventricular end-diastolic dimension (LVEDD) (hazard ratio, 1.034; 95% confidence interval, 1.004–1.066) at admission. Patients with RBBB and an LVEDD of ≥63 mm had the highest mortality (log-rank χ2 = 14.854), P<0.05. Conclusion RBBB was an independent predictor of all-cause mortality, and the combination of RBBB and LVEDD provided more clinically relevant information than RBBB alone for assessing the risk of all-cause mortality in patients with IDCM.

The Effect of Atrasentan on Kidney and Heart Failure Outcomes by Baseline Albuminuria and Kidney Function

2021 ◽  
pp. CJN.07340521
Author(s):  
Simke W. Waijer ◽  
Ron T. Gansevoort ◽  
George L. Bakris ◽  
Ricardo Correa-Rotter ◽  
Fan-Fan Hou ◽  
...  
Keyword(s):  
Heart Failure ◽  
Diabetic Nephropathy ◽  
Relative Risk ◽  
Confidence Interval ◽  
Kidney Failure ◽  
Absolute Risk ◽  
Hazard Ratio ◽  
Baseline Risk ◽  
Heart Failure Hospitalization ◽  
Clinical Trial Registry

Background and objectivesAtrasentan reduces the risk of kidney failure but increases the risk of edema and, possibly, heart failure. Patients with severe CKD may obtain greater absolute kidney benefits from atrasentan but may also be at higher risk of heart failure. We assessed relative and absolute effects of atrasentan on kidney and heart failure events according to baseline eGFR and urinary albumin-creatinine ratio (UACR) in a post hoc analysis of the Study of Diabetic Nephropathy with Atrasentan (SONAR) trial.Design, setting, participants, & measurementsThe effect of atrasentan versus placebo in 3668 patients with type 2 diabetes and CKD with elevated albuminuria was examined in the SONAR trial. We used Cox proportional hazards regression analysis to study effects on the primary kidney outcome (composite of doubling of serum creatinine, kidney failure, or kidney death) and heart failure hospitalization across subgroups of eGFR (<30, ≥30–45, and ≥45 ml/min per 1.73 m2) and UACR (<1000, ≥1000–3000, and ≥3000 mg/g).ResultsAtrasentan reduced the relative risk of the primary kidney outcome (hazard ratio, 0.71; 95% confidence interval, 0.58 to 0.88) consistently across all subgroups of baseline eGFR and UACR (all P interaction >0.21). Patients in the highest UACR and lowest eGFR subgroups, in whom rates of the primary kidney outcome were highest, showed the largest absolute benefit (all P interaction <0.01). The risk of heart failure hospitalization was higher in the atrasentan group (hazard ratio, 1.39; 95% confidence interval, 0.97 to 1.99) and was consistent across subgroups, with no evidence that relative or absolute risks differed across eGFR or UACR subgroups (all P interaction >0.09).ConclusionsAtrasentan reduced the relative risk of the primary kidney outcome consistently across baseline UACR and eGFR subgroups. The absolute risk reduction was greater among patients in the lowest eGFR and highest albuminuria category who were at highest baseline risk. Conversely, the relative and absolute risks of heart failure hospitalization were similar across baseline UACR and eGFR subgroups.Clinical Trial registry name and registration number: Study of Diabetic Nephropathy with Atrasentan (SONAR), NCT01858532

UPSTROKE TIME PER CARDIAC CYCLE IS ASSOCIATED WITH CARDIOVASCULAR PROGNOSIS IN TYPE 2 DIABETES

2019 ◽  
Vol 25 (11) ◽  
pp. 1109-1116 ◽  
Author(s):  
Li-Hsin Chang ◽  
Chii-Min Hwu ◽  
Chia-Huei Chu ◽  
Justin G.S. Won ◽  
Harn-Shen Chen ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Confidence Interval ◽  
Cardiac Cycle ◽  
Hazard Ratio ◽  
All Cause Mortality ◽  
Composite Events ◽  
Artery Disease

Objective: Upstroke time per cardiac cycle (UTCC) in the lower extremities has been found to be predictive of cardiovascular mortality in the general population. Therefore, the purpose of the study was to test the associations between increasing UTCC and outcomes in patients with type 2 diabetes. Methods: A total of 452 patients with type 2 diabetes (age, 67.5 ± 8.6 years; male, 54%) registered in a share-care program participated in the study at an outpatient clinic in Taipei Veterans General Hospital across a mean of 5.8 years. Primary outcomes were all-cause mortality hospitalization for coronary artery disease, stroke, revascularization, amputation, and diabetic foot syndrome. Secondary end-point outcome was all-cause mortality. Results: Increment of UTCC associations with primary and secondary outcomes were undertaken prior to baseline characteristic adjustments. A UTCC of 20.1% exhibited the greatest area under curve (AUC), sensitivity, and specificity balance to predict composite events in receiver operating curves (AUC, 0.63 [ P = .001]; sensitivity, 67.7%; specificity, 54.9%). Sixty-four composite events and 17 deaths were identified from medical records. UTCC ≥20.1% was associated with the occurrence of composite events and an increased risk of mortality. For composite events, an adjusted hazard ratio (HR) of 2.45 and 95% confidence interval (CI) of 1.38 to 4.35 ( P = .002) were calculated. For all-cause mortality, an adjusted HR of 1.91 and 95% CI of 0.33 to 10.99 ( P = .467) were calculated. Conclusion: Increasing UTCC was associated with cardiovascular outcomes in patients with type 2 diabetes. Therefore, UTCC is advocated as a noninvasive screening tool for ambulatory patients with type 2 diabetes. Abbreviations: CAD = coronary artery disease; CI = confidence interval; eGFR = estimated glomerular filtration rate; HR = hazard ratio; PAD = peripheral artery disease; UTCC = upstroke time per cardiac cycle

Long-term outcomes in adults with repaired tetralogy of Fallot and pulmonary atresia

2019 ◽  
Vol 29 (8) ◽  
pp. 1078-1081
Author(s):  
Alexander C. Egbe ◽  
Juan Crestanello ◽  
Joseph A. Dearani ◽  
Karim Osman ◽  
Keerthana Banala ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Tetralogy Of Fallot ◽  
Congenital Heart ◽  
Adult Congenital Heart Disease ◽  
Pulmonary Atresia ◽  
Hazard Ratio ◽  
Disease Clinic ◽  
Repaired Tetralogy Of Fallot ◽  
All Cause Mortality ◽  
Adult Congenital

AbstractBackground:There are limited outcome data in adults with tetralogy of Fallot and pulmonary atresia. The purpose of this study was to describe re-operations and all-cause mortality in adults with tetralogy of Fallot and pulmonary atresia.Methods:Retrospective review of adults with repaired tetralogy of Fallot and pulmonary atresia who received care at the Mayo Adult Congenital Heart Disease Clinic, 1990–2016. All-cause mortality was calculated as events per 100 patient-years from the time of first presentation to the Adult Congenital Heart Disease Clinic.Results:Of the 221 patients, the age at initial tetralogy of Fallot repair was 6 (5–13) years, and the age at first presentation to the clinic was 27 – 8 years. All patients had at least one right ventricular to pulmonary artery conduit re-operation. There were 31 deaths (14%) at mean age of 41 – 14 years. The causes of death were end-stage heart failure (n = 17), sudden cardiac death (n=9), post-operative death after cardiac surgery (n = 2), sepsis with multi-system organ failure (n = 2), and unknown (n = 1). All-cause mortality rate was 1.7 per 100 patient-years. The risk factors for all-cause mortality were older age (>12 years) at the time of repair (hazard ratio 1.41, 95 confidence interval 1.06–2.02, p = 0.033), non-sustained ventricular tachycardia (hazard ratio 1.36, 95 confidence interval 1.17–2.47, p = 0.015), and left ventricular ejection fraction <50% (hazard ratio 1.39, 95 confidence interval 1.08–2.31, p = 0.031).Conclusion:Based on a review of 221 adults with repaired tetralogy of Fallot and pulmonary atresia, all patients had re-operations and all-cause mortality rate was 1.7 events per 100 patient-years. The current study provides important outcomes data for risk stratification in adults with tetralogy of Fallot and pulmonary atresia.

scholarly journals Cardiovascular Disease and All-Cause Mortality in Male Twins With Discordant Cardiorespiratory Fitness: A Nationwide Cohort Study

2020 ◽  
Vol 189 (10) ◽  
pp. 1114-1123
Author(s):  
Marcel Ballin ◽  
Anna Nordström ◽  
Peter Nordström
Keyword(s):  
Cardiovascular Disease ◽  
Cohort Study ◽  
Confidence Interval ◽  
Cardiorespiratory Fitness ◽  
Military Service ◽  
Lower Risk ◽  
Hazard Ratio ◽  
Familial Factors ◽  
All Cause Mortality

Abstract Whether genetic and familial factors influence the association between cardiorespiratory fitness (CRF) and cardiovascular disease (CVD) is unknown. Two cohorts were formed based on data from 1,212,295 men aged 18 years who were conscripted for military service in Sweden during 1972–1996. The first comprised 4,260 twin pairs in which the twins in each pair had different CRF (≥1 watt). The second comprised 90,331 nonsibling pairs with different CRF and matched on birth year and year of conscription. Incident CVD and all-cause mortality were identified using national registers. During follow-up (median 32 years), there was no difference in CVD and mortality between fitter twins and less fit twins (246 vs. 251 events; hazard ratio (HR) = 1.00, 95% confidence interval (CI): 0.83, 1.20). The risks were similar in twin pairs with ≥60-watt difference in CRF (HR = 0.96, 95% CI: 0.57, 1.64). In contrast, in the nonsibling cohort, fitter men had a lower risk of the outcomes than less fit men (4,444 vs. 5,298 events; HR = 0.83, 95% CI: 0.79, 0.86). The association was stronger in pairs with ≥60-watt difference in CRF (HR = 0.65, 95% CI: 0.59, 0.71). These findings indicate that genetic and familial factors influence the association of CRF with CVD and mortality.

scholarly journals Association between serum α1-antitrypsin levels and all-cause mortality in the general population: the Nagahama study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yasuharu Tabara ◽  
Kazuya Setoh ◽  
Takahisa Kawaguchi ◽  
Shinji Kosugi ◽  
Takeo Nakayama ◽  
...  
Keyword(s):  
Risk Factor ◽  
General Population ◽  
Confidence Interval ◽  
Cox Model ◽  
Prognostic Significance ◽  
High Sensitivity ◽  
Hazard Ratio ◽  
Reactive Protein ◽  
All Cause Mortality ◽  
Study Participants

AbstractCirculating levels of inflammatory proteins have to be prognostic markers of all-cause mortality. α1-Antitrypsin (AAT) is a major inflammatory plasma protein, but its association with all-cause mortality is unclear. We aimed to evaluate the prognostic significance of AAT levels for all-cause mortality. Study participants comprised 9682 community residents (53.5 ± 13.3 years old). During the 9.8-year follow-up period, 313 participants died from any cause. The mortality rate increased linearly with AAT quintiles (Q1, 18.2; Q2, 24.7; Q3, 23.8; Q4, 31.9; Q5, 64.6 per 10,000 person-years). There were significant correlations between AAT and high-sensitivity C-reactive protein (hsCRP) levels (correlation coefficient, 0.331; P < 0.001). However, the Cox model analysis, when adjusted for possible covariates including hsCRP, identified the fifth AAT quintile as a risk factor for all-cause death (hazard ratio, 2.12 [95% confidence interval, 1.41–3.18]; P < 0.001). An analysis of participants older than 50 years (hazard ratio, 1.98, P < 0.001) yielded similar results. The hazard ratio increased proportionately in combination with high AAT and high hsCRP levels, and the highest hazard ratio reached 4.51 (95% confidence interval, 3.14–6.54, P < 0.001). High AAT levels were determined to be an independent risk factor for mortality in the general population.

scholarly journals Clinical Efficacy and Safety of Cox-Maze IV Procedure for Atrial Fibrillation in Patients With Hypertrophic Obstructive Cardiomyopathy

2021 ◽  
Vol 8 ◽  
Author(s):  
Yanhai Meng ◽  
Yanbo Zhang ◽  
Ping Liu ◽  
Changsheng Zhu ◽  
Tao Lu ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Confidence Interval ◽  
Antiarrhythmic Drugs ◽  
Hypertrophic Obstructive Cardiomyopathy ◽  
Hazard Ratio ◽  
Atrial Fibrillation Recurrence ◽  
Surgical Ablation ◽  
Term Survival ◽  
Septal Myectomy ◽  
All Cause Mortality

Objective: Atrial fibrillation is the most prevalent persistent arrhythmia in patients with hypertrophic obstructive cardiomyopathy. Comparative analyses of the safety and effectiveness of septal myectomy with and without surgical ablation are limited. This study aimed to compare the outcomes of septal myectomy with and without the Cox-maze IV procedure in patients with hypertrophic obstructive cardiomyopathy and atrial fibrillation.Methods: Ninety-four patients with hypertrophic obstructive cardiomyopathy and atrial fibrillation who underwent septal myectomy were analyzed, we divided it into concomitant Cox maze surgery (Cox-maze group) and no concomitant Cox maze operation (no Cox-maze group). Freedom from atrial fibrillation recurrence and all-cause mortality after surgery were assessed.Results: Freedom from all-cause mortality after septal myectomy at 1, 3, and 5 years was 98.5 ± 1.5% each in the Cox-maze group and 90.8 ± 6.3%, 85.1 ± 8.1%, and 85.1 ± 8.1%, respectively, in the no Cox-maze group. Patients in the no Cox-maze group had lower survival, freedom from atrial fibrillation recurrence off antiarrhythmic drugs, and arrhythmia control rate (including patients with successful antiarrhythmic drug conversion) than those in the Cox-maze group (P = 0.046, P = 0.040, and P = 0.012, respectively). Patients who underwent the Cox-maze IV procedure had lower atrial fibrillation recurrence rate than those who did not (hazard ratio, 0.141; 95% confidence interval, 0.042–0.479; P = 0.002). Post-operative increases in left atrial diameters (hazard ratio, 1.099; 95% confidence interval, 1.024–1.179; P = 0.009) were associated with atrial fibrillation recurrence.Conclusions: The Cox-maze IV procedure combined with septal myectomy improved mid-term survival and reduced mid-term atrial fibrillation recurrence in patients with hypertrophic obstructive cardiomyopathy and atrial fibrillation. The concomitant Cox-maze IV procedure was associated with a lower atrial fibrillation recurrence in patients with surgical hypertrophic obstructive cardiomyopathy and atrial fibrillation.

scholarly journals Safety of Intravenous Iron in Dialysis

2018 ◽  
Vol 13 (3) ◽  
pp. 457-467 ◽  
Author(s):  
Ingrid Hougen ◽  
David Collister ◽  
Mathieu Bourrier ◽  
Thomas Ferguson ◽  
Laura Hochheim ◽  
...  
Keyword(s):  
Relative Risk ◽  
Confidence Interval ◽  
Randomized Controlled Trials ◽  
Cardiovascular Events ◽  
Observational Studies ◽  
Intravenous Iron ◽  
Hazard Ratio ◽  
Controlled Trials ◽  
Randomized Controlled

Background and objectivesThe safety of intravenous iron dosing in dialysis is uncertain. Higher-dose intravenous iron may be associated with a higher risk of infections, cardiovascular events, hospitalizations, and mortality. This systematic review aimed to determine the safety of higher-dose versus lower-dose intravenous iron, oral iron, or no iron supplementation in adult patients treated with dialysis.Design, setting, participants, & measurementsWe searched Medline, EMBASE, Cochrane library, and CINAHL from inception to January 6, 2017 for randomized, controlled trials and observational studies comparing higher-dose intravenous iron with lower-dose intravenous iron, oral iron, or no iron in patients treated with dialysis that had all-cause mortality, infection, cardiovascular events, or hospitalizations as outcomes.ResultsOf the 2231 eligible studies, seven randomized, controlled trials and 15 observational studies met inclusion criteria. The randomized, controlled trials showed no association between higher-dose intravenous iron (>400 mg/mo for most studies) and mortality (six studies; n=970; pooled relative risk, 0.93; 95% confidence interval, 0.47 to 1.84; follow-up ranging from 35 days to 26 months) or infection (four studies; n=743; relative risk, 1.02; 95% confidence interval, 0.74 to 1.41). The observational studies showed no association between higher-dose intravenous iron (>200 mg/mo for most studies) and mortality (eight studies; n=241,408; hazard ratio, 1.09; 95% confidence interval, 0.98 to 1.21; follow-up ranging from 3 to 24 months), infection (eight studies; n=135,532; pooled hazard ratio, 1.13; 95% confidence interval, 0.99 to 1.28), cardiovascular events (seven studies; n=135,675; hazard ratio, 1.18; 95% confidence interval, 0.90 to 1.56), or hospitalizations (five studies; n=134,324; hazard ratio, 1.08; 95% confidence interval, 0.97 to 1.19).ConclusionsHigher-dose intravenous iron does not seem to be associated with higher risk of mortality, infection, cardiovascular events, or hospitalizations in adult patients on dialysis. Strength of this finding is limited by small numbers of participants and events in the randomized, controlled trials and statistical heterogeneity in observational studies.

Short-term prognosis of normalising serum potassium following an episode of hypokalaemia in patients with chronic heart failure

2020 ◽  
pp. 204748732091115
Author(s):  
Mette Aldahl ◽  
Christoffer Polcwiartek ◽  
Line Davidsen ◽  
Kristian Kragholm ◽  
Peter Søgaard ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Confidence Interval ◽  
Mortality Risk ◽  
Cardiovascular Mortality ◽  
Serum Potassium ◽  
Reference Group ◽  
Hazard Ratio ◽  
Increased Risk ◽  
All Cause Mortality

Background/aim It is well known that patients with chronic heart failure and hypokalaemia have increased mortality risk. We investigated the impact of normalising serum potassium following an episode of hypokalaemia on short-term mortality among patients with chronic heart failure. Methods and results We identified 1673 patients diagnosed with chronic heart failure who had a serum potassium measurement under 3.5 mmol/l within 14 days and one year after initiated medical treatment with both loop diuretics and angiotensin-converting enzyme inhibitors or angiotensin-II receptor blockers. A second serum potassium measurement was required 8–30 days after the episode of hypokalaemia. All-cause mortality and cardiovascular mortality was examined within 90 days from the second serum potassium measurement. Mortality was examined according to six predefined potassium groups derived from the second measurement:<3.5 mmol/l ( n = 302), 3.5–3.7 mmol/l ( n = 271), 3.8–4.1 mmol/l ( n = 464), 4.2–4.4 mmol/l ( n = 270), 4.5–5.0 mmol/l ( n = 272), and 5.1–8.0 mmol/l ( n = 94). We used Cox regression to estimate both all-cause mortality risk and cardiovascular mortality, with serum potassium at 3.8–4.1 mmol/l as reference. After 90 days, the all-cause mortality in the six groups was 29.5%, 22.1%, 20.3%, 24.8%, 23.5% and 43.6%, respectively. In multivariable adjusted analysis, patients with serum potassium <3.5 mmol/l (hazard ratio: 1.51; 95% confidence interval: 1.13–2.02) and serum potassium 5.1–8.0 mmol/l (hazard ratio: 2.18; 95% confidence interval: 1.50–3.17) had an increased risk of all-cause mortality compared to the reference. After 90 days, the cardiovascular mortality in the six groups was 19.2%, 17.7%, 14.4%, 18.9%, 18.8% and 34.0%, respectively. In multivariable adjusted analysis, patients with serum potassium 5.1–8.0 mmol/l (hazard ratio: 2.32; 95% confidence interval: 1.51–3.56) had an increased risk of cardiovascular mortality compared to the reference, while serum potassium <3.5 mmol/l (hazard ratio: 1.37; 95% confidence interval: 0.97–1.95) had a trend toward increased risk of cardiovascular mortality compared to the reference. Conclusion Patients with chronic heart failure and hypokalaemia, who after 8–30 days remained hypokalaemic, had a significantly higher 90-day all-cause mortality risk compared to patients in the reference group (3.8–4.1 mmol/l). Patients with chronic heart failure and hypokalaemia, who after 8–30 days had the serum potassium level increased to a level within 5.1–8.0 mmol/l, had both a significantly higher 90-day all-cause mortality risk and cardiovascular mortality risk compared to patients in the reference group (3.8–4.1 mmol/l).

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