11 Frailty and the Rate of Fractures in Patients Initiated on Antihypertensive Medication

Abstract Introduction There is concern regarding adverse effects of antihypertensive treatment, including falls and subsequent fractures, especially hip fractures. As frailty is increasingly recognised as an important risk factor for adverse outcomes, we examined its relationship to fracture rates in older patients after starting antihypertensives. Methods Using the Clinical Practice Research Datalink (CPRD), we identified participants over 65-years old starting a first-line antihypertensive medication. Using deficits identified in CPRD we classified patient-level frailty as “Fit”, “Mild”, “Moderate” or “Severe” using the Electronic Frailty Index. We calculated the rate of fractures by frailty level and fracture site, and determined the rate ratio (RR) of first fracture by frailty level, adjusting for confounding, using multivariable poisson regression. We conducted sensitivity analyses to additionally adjust for ethnicity, deprivation, and bisphosphonate use. Results 44% of participants were classified as mildly frail or greater, but frail participants experienced 58% of all fractures, and 63% of hip fractures. The whole cohort showed a crude rate of 14.1 fractures/1000 person-years, with 4.5 hip fractures/1000 person-years. In severe frailty, this rises to 51.0 fractures/1000 person-years, and 17.7 hip fractures/1000 person-years. After adjustment for confounding, increasing frailty was associated with greater rate of any fracture, reaching RR 2.85 (95% confidence interval 2.43–3.33) for severe frailty versus fit. Results were unchanged in sensitivity analyses. Conclusions Frailty and fracture are both common in older participants who start antihypertensive medications. Increasing frailty was positively associated with increased rates of fracture. Clinicians need awareness of this relationship to consider fracture risk assessment and prevention in these patients.

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ACE inhibitor use and risk of cataract: a case–control analysis

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2018-312980 ◽

2019 ◽

Vol 103 (11) ◽

pp. 1561-1565 ◽

Cited By ~ 1

Author(s):

Claudia Becker ◽

Susan S Jick ◽

Christoph R Meier

Keyword(s):

Observational Study ◽

Index Date ◽

Antihypertensive Drugs ◽

Conditional Logistic Regression ◽

Case Control ◽

Sensitivity Analyses ◽

Practice Research ◽

Clinical Practice Research Datalink ◽

Control Analysis ◽

Increased Risk

Background/AimUse of ACE inhibitors (ACEIs) has been associated with an increased risk of cataract in a previous observational study in humans. In contrast, ACEIs were associated with beneficial effects on cataract development in experimental studies. We assessed the risk of cataract in relation to exposure to ACEI and other antihypertensive drugs.MethodsThis is a case-control study based on data from the UK-based Clinical Practice Research Datalink (CPRD). We included first-time cataract patients aged ≥40 years between 1995 and 2015 and an equal number of cataract-free controls. We matched the controls to cases on age, sex, general practice, date of first cataract (ie, index date) and years of history in the CPRD prior to the index date. We assessed the number of prescriptions for ACEI and other antihypertensive drugs in detail and explored the use of single ACEI substances. We performed conditional logistic regression and conducted various sensitivity analyses to test the robustness of our findings. We calculated the risk of cataract associated with previous exposure to ACEI, measured as OR with 95% CIs, and adjusted the multivariable model for body mass index, smoking, diabetes, hypertension, prescriptions of systemic corticosteroids and other antihypertensive drugs.ResultsWe identified 206 931 cataract cases and the same number of matched controls. Use of ACEI was not associated with a materially altered risk of cataract compared with non-use of ACEI, neither in the main analysis (OR 1.06, 95% CI 1.04 to 1.08) nor in any of the sensitivity or stratified analyses.ConclusionIn our large observational study, use of ACEI was not associated with an altered risk of cataract.

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Factors associated with excess all-cause mortality in the first wave of the COVID-19 pandemic in the UK: A time series analysis using the Clinical Practice Research Datalink

PLoS Medicine ◽

10.1371/journal.pmed.1003870 ◽

2022 ◽

Vol 19 (1) ◽

pp. e1003870

Author(s):

Helen Strongman ◽

Helena Carreira ◽

Bianca L. De Stavola ◽

Krishnan Bhaskaran ◽

David A. Leon

Keyword(s):

Time Series ◽

Learning Disabilities ◽

Clinical Practice ◽

Excess Mortality ◽

Negative Binomial ◽

Sensitivity Analyses ◽

Practice Research ◽

Clinical Practice Research Datalink ◽

All Cause Mortality ◽

The Uk

Background Excess mortality captures the total effect of the Coronavirus Disease 2019 (COVID-19) pandemic on mortality and is not affected by misspecification of cause of death. We aimed to describe how health and demographic factors were associated with excess mortality during, compared to before, the pandemic. Methods and findings We analysed a time series dataset including 9,635,613 adults (≥40 years old) registered at United Kingdom general practices contributing to the Clinical Practice Research Datalink. We extracted weekly numbers of deaths and numbers at risk between March 2015 and July 2020, stratified by individual-level factors. Excess mortality during Wave 1 of the UK pandemic (5 March to 27 May 2020) compared to the prepandemic period was estimated using seasonally adjusted negative binomial regression models. Relative rates (RRs) of death for a range of factors were estimated before and during Wave 1 by including interaction terms. We found that all-cause mortality increased by 43% (95% CI 40% to 47%) during Wave 1 compared with prepandemic. Changes to the RR of death associated with most sociodemographic and clinical characteristics were small during Wave 1 compared with prepandemic. However, the mortality RR associated with dementia markedly increased (RR for dementia versus no dementia prepandemic: 3.5, 95% CI 3.4 to 3.5; RR during Wave 1: 5.1, 4.9 to 5.3); a similar pattern was seen for learning disabilities (RR prepandemic: 3.6, 3.4 to 3.5; during Wave 1: 4.8, 4.4 to 5.3), for black or South Asian ethnicity compared to white, and for London compared to other regions. Relative risks for morbidities were stable in multiple sensitivity analyses. However, a limitation of the study is that we cannot assume that the risks observed during Wave 1 would apply to other waves due to changes in population behaviour, virus transmission, and risk perception. Conclusions The first wave of the UK COVID-19 pandemic appeared to amplify baseline mortality risk to approximately the same relative degree for most population subgroups. However, disproportionate increases in mortality were seen for those with dementia, learning disabilities, non-white ethnicity, or living in London.

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Prevalence of comorbid mental and physical illnesses and risks for self-harm and premature death among primary care patients diagnosed with fatigue syndromes

Psychological Medicine ◽

10.1017/s0033291719001065 ◽

2019 ◽

Vol 50 (7) ◽

pp. 1156-1163

Author(s):

Matthew J. Carr ◽

Darren M. Ashcroft ◽

Peter D. White ◽

Nav Kapur ◽

Roger T. Webb

Keyword(s):

Cox Regression ◽

Premature Mortality ◽

Premature Death ◽

Epidemiological Studies ◽

Adverse Outcomes ◽

Practice Research ◽

Clinical Practice Research Datalink ◽

Hazard Ratios ◽

History Of ◽

Self Harm

AbstractBackgroundFatigue syndromes (FSs) affect large numbers of individuals, yet evidence from epidemiological studies on adverse outcomes, such as premature death, is limited.MethodsCohort study involving 385 general practices in England that contributed to the Clinical Practice Research Datalink (CPRD) with linked inpatient Hospital Episode Statistics (HES) and Office for National Statistics (ONS) cause of death information. A total of 10 477 patients aged 15 years and above, diagnosed with a FS during 2000–2014, were individually matched with up to 20 comparator patients without a history of having a FS. Prevalence ratios (PRs) were estimated to compare the FS and comparison cohorts on clinical characteristics. Adjusted hazard ratios (HRs) for subsequent adverse outcomes were estimated from stratified Cox regression models.ResultsAmong patients diagnosed with FSs, we found elevated baseline prevalence of: any psychiatric illness (PR 1.77; 95% CI 1.72–1.82), anxiety disorders (PR 1.92; 1.85–1.99), depression (PR 1.89; 1.83–1.96), psychotropic prescriptions (PR 1.68; 1.64–1.72) and comorbid physical illness (PR 1.28; 1.23–1.32). We found no significant differences in risks for: all-cause mortality (HR 0.99; 0.91–1.09), natural death (HR 0.99; 0.90–1.09), unnatural death (HR 1.00; 0.59–1.72) or suicide (HR 1.68; 0.78–3.63). We did, however, observe a significantly elevated non-fatal self-harm risk: HR 1.83; 1.56–2.15.ConclusionsThe absence of elevated premature mortality risk is reassuring. The raised prevalence of mental illness and increased non-fatal self-harm risk indicate a need for enhanced assessment and management of psychopathology associated with fatigue syndromes.

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Degree of serotonin reuptake inhibition of antidepressants and ischemic risk

Neurology ◽

10.1212/wnl.0000000000008060 ◽

2019 ◽

Vol 93 (10) ◽

pp. e1010-e1020 ◽

Cited By ~ 7

Author(s):

Antonios Douros ◽

Sophie Dell'Aniello ◽

Golsa Dehghan ◽

Jean-François Boivin ◽

Christel Renoux

Keyword(s):

Ischemic Stroke ◽

Serotonin Reuptake ◽

Selective Serotonin Reuptake Inhibitors ◽

Conditional Logistic Regression ◽

Large Population ◽

Sensitivity Analyses ◽

Practice Research ◽

Clinical Practice Research Datalink ◽

Third Generation

ObjectiveTo assess whether use of antidepressants with strong inhibition of serotonin reuptake is associated with a decreased incidence of ischemic stroke and myocardial infarction (MI).MethodsWe conducted a cohort study using the UK Clinical Practice Research Datalink and considering new users of selective serotonin reuptake inhibitors (SSRIs) or third-generation antidepressants who were ≥18 years of age between 1995 and 2014. Using a nested case-control approach, we matched each case of a first ischemic stroke or MI identified during follow-up with up to 30 controls on age, sex, calendar time, and duration of follow-up. We estimated incidence rate ratios (RRs) and 95% confidence intervals (CIs) of each outcome associated with current use of strong compared with weak inhibitors of serotonin reuptake using conditional logistic regression.ResultsThe cohort included 938,388 incident users of SSRIs (n = 868,755) or third-generation antidepressants (n = 69,633). Mean age at cohort entry was 46 years (64% women). During follow-up, 15,860 cases of ischemic stroke and 8,626 cases of MI were identified and matched to 473,712 and 258,022 controls, respectively. Compared with current use of weak inhibitors of serotonin reuptake, current use of strong inhibitors was associated with a decreased rate of ischemic stroke (RR 0.88, 95% CI 0.80–0.97), but the effect size was smaller in some sensitivity analyses. The rate of MI was similar between strong and weak inhibitors (RR 1.00, 95% CI 0.87–1.15).ConclusionOur large population-based study suggests that antidepressants strongly inhibiting serotonin reuptake may be associated with a small decrease in the rate of ischemic stroke.

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Comparative effect of statins on the risk of incident Alzheimer disease

Neurology ◽

10.1212/wnl.0000000000004818 ◽

2017 ◽

Vol 90 (3) ◽

pp. e179-e187 ◽

Cited By ~ 16

Author(s):

Liliya Sinyavskaya ◽

Serge Gauthier ◽

Christel Renoux ◽

Sophie Dell'Aniello ◽

Samy Suissa ◽

...

Keyword(s):

Clinical Practice ◽

Alzheimer Disease ◽

Proportional Hazards ◽

Neuroprotective Effect ◽

Incidence Rates ◽

Cox Proportional Hazards ◽

Sensitivity Analyses ◽

Practice Research ◽

Clinical Practice Research Datalink ◽

Increased Risk

ObjectiveTo investigate whether fungus-derived statins are associated with a lower risk of incident Alzheimer disease (AD) compared with synthetic statins using real-world clinical practice data.MethodsWe identified a population-based retrospective cohort of patients aged ≥60 years newly prescribed a statin between January 1, 1994, and December 31, 2012, and followed until March 31, 2015, using the UK Clinical Practice Research Datalink. Statins were consecutively classified according to their type, lipophilicity, and potency. For each group, we calculated the crude AD incidence rates per 1,000 person-years. Time-dependent Cox proportional hazards models adjusted for propensity score deciles were used to estimate hazard ratios (HRs) with 95% confidence interval (CIs) of incident AD associated with different statin categories.ResultsOver the 18-year study period, we identified 465,085 statin users, including 7,669 patients who developed AD during 2,891,268 person-years of follow-up (incidence rate 2.65 [95% CI 2.59–2.71] per 1,000 person-years). Compared to synthetic, fungus-derived statins were associated with an increased risk of AD (HR 1.09, 95% CI 1.03–1.15). Lipophilic statins also were associated with higher AD risk (HR 1.18, 95% CI 1.09–1.27) compared to hydrophilic statins, while statin potency did not modify the risk of AD (adjusted HR 1.03, 95% CI 0.98–1.08). The risk was further reduced in sensitivity analyses.ConclusionFungus-derived and lipophilic statins were not associated with decreased incidence of AD compared to synthetic and hydrophilic statins. The modest variations in the risk of incident AD observed between statin characteristics needs to be evaluated in future studies on their possible heterogeneous neuroprotective effect.

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Anticoagulant prescribing for atrial fibrillation and risk of incident dementia

Heart ◽

10.1136/heartjnl-2021-319672 ◽

2021 ◽

pp. heartjnl-2021-319672

Author(s):

Sharon Louise Cadogan ◽

Emma Powell ◽

Kevin Wing ◽

Angel Yun Wong ◽

Liam Smeeth ◽

...

Keyword(s):

Atrial Fibrillation ◽

Oral Anticoagulant ◽

Vitamin K Antagonists ◽

Oral Anticoagulants ◽

Sensitivity Analyses ◽

Practice Research ◽

Clinical Practice Research Datalink ◽

Historical Cohort ◽

Incident Dementia ◽

First Time

ObjectiveThe aim of this study was to investigate the association between oral anticoagulant type (direct oral anticoagulants (DOACs) vs vitamin K antagonists (VKAs)) and incident dementia or mild cognitive impairment (MCI) among patients with newly diagnosed atrial fibrillation (AF).MethodsUsing linked electronic health record (EHR) data from the Clinical Practice Research Datalink in the UK, we conducted a historical cohort study among first-time oral anticoagulant users with incident non-valvular AF diagnosed from 2012 to 2018. We compared the incidence of (1) clinically coded dementia and (2) MCI between patients prescribed VKAs and DOACs using Cox proportional hazards regression models, with age as the underlying timescale, accounting for calendar time and time on treatment, sociodemographic and lifestyle factors, clinical comorbidities and medications.ResultsOf 39 200 first-time oral anticoagulant users (44.6% female, median age 76 years, IQR 68–83), 20 687 (53%) were prescribed a VKA and 18 513 (47%) a DOAC at baseline. Overall, 1258 patients (3.2%) had GP-recorded incident dementia, incidence rate 16.5 per 1000 person-years. DOAC treatment for AF was associated with a 16% reduction in dementia diagnosis compared with VKA treatment in the whole cohort (adjusted HR 0.84, 95% CI: 0.73 to 0.98) and with a 26% reduction in incident MCI (adjusted HR 0.74, 95% CI: 0.65 to 0.84). Findings were similar across various sensitivity analyses.ConclusionsIncident EHR-recorded dementia and MCI were less common among patients prescribed DOACs for new AF compared with those prescribed VKAs.

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Antihypertensive Medications and COVID-19 Diagnosis and Mortality: Population-based Case-Control Analysis in the United Kingdom

10.1101/2020.09.25.20201731 ◽

2020 ◽

Cited By ~ 1

Author(s):

Emma Rezel-Potts ◽

Abdel Douiri ◽

Phil J Chowienczyk ◽

Martin C Gulliford

Keyword(s):

Antihypertensive Therapy ◽

Population Based ◽

Case Control ◽

Practice Research ◽

Clinical Practice Research Datalink ◽

Control Analysis ◽

Antihypertensive Medications ◽

Lower Odds ◽

Healthcare Seeking ◽

Increased Risk

Objectives: To evaluate antihypertensive medications and COVID-19 diagnosis and mortality, accounting for healthcare seeking behaviour. Design: A population-based case control study with additional cohort analysis. Setting: Primary care patients from the UK Clinical Practice Research Datalink (CPRD). Participants: 16 866 patients with COVID-19 events in the CPRD from 29th January to June 25th 2020 and 70 137 matched controls. Main outcome measures: We explored associations between COVID-19 diagnosis and prescriptions for angiotensin converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), beta-blockers (B), calcium-channel blockers (C), thiazide diuretics (D) and other antihypertensive drugs (O). We evaluated all-cause mortality among COVID-19 cases. Analyses were adjusted for covariates and consultation frequency. Results: In covariate adjusted analyses, ACEIs were associated with lower odds of COVID-19 diagnosis (0.82, 95% confidence interval 0.77 to 0.88) as were ARBs, 0.87 (0.80 to 0.95) with little attenuation from adjustment for consultation frequency. In fully adjusted analyses, C and D were also associated with lower odds of COVID-19. Increased odds of COVID-19 for B (1.19, 1.12 to 1.26), were attenuated after adjustment for consultation frequency (1.01, 0.95 to 1.08). In adjusted analyses, patients treated with ACEIs or ARBs had similar mortality to patients treated with classes B, C, D or O (1.00, 0.83 to 1.20) or patients receiving no antihypertensive therapy (0.99, 0.83 to 1.18). Conclusions: Associations were sensitive to adjustment for confounding and healthcare seeking, but there was no evidence that antihypertensive therapy is associated with increased risk of COVID-19 diagnosis or mortality; most classes of antihypertensive therapy showed negative associations with COVID-19 diagnosis.

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1263 Does Multimorbidity Influence the Likelihood of Receiving A Total Hip Replacement for Osteoarthritis?

British Journal of Surgery ◽

10.1093/bjs/znab259.1038 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

R Ferguson ◽

D Prieto-Alhambra ◽

G Peat ◽

K Jordan ◽

J Valderas ◽

...

Keyword(s):

Total Hip Replacement ◽

Hip Replacement ◽

Frailty Index ◽

Hip Osteoarthritis ◽

Healthcare Management ◽

Practice Research ◽

Clinical Practice Research Datalink ◽

Total Hip ◽

Kaplan Meier ◽

The Uk

Abstract Introduction Limited data are available on the influence of multimorbidity on the outcomes of total hip replacement for patients with hip osteoarthritis. Thus, patients with multimorbidity and their clinicians across the UK are making decisions on whether or not to proceed with total hip replacement without clear information available on the potential risks and benefits. It is not known how such patients are currently managed. The aim of this study was to investigate the influence of multimorbidity on the likelihood of receiving total hip replacement in patients with hip osteoarthritis in the UK. Method A cohort study was performed, with cohort comprised of all patients over 65 years with a diagnosis of hip osteoarthritis recorded in Clinical Practice Research Datalink. Severity of multimorbidity burden was measured using four different scores (Charlson Comorbidity Index, Electronic Frailty Index, count of drugs prescribed, count of primary care interactions). The outcome was total hip replacement, evaluated using Kaplan-Meier survival and competing-risk analyses. Results 28,025 patients were included. 10,948 patients underwent total hip replacement. Increased multimorbidity burden was associated with decreased likelihood of undergoing surgery, irrespective of the method of scoring multimorbidity. Electronic Frailty Index had the largest difference between categories. Adjusted hazard ratio (‘severe multimorbidity versus ‘fit’) was 0.34 (95% CI 0.22, 0.51). Conclusions Patients with hip osteoarthritis and concurrent multimorbidity were up to two thirds less likely to undergo total hip replacement. Whether this difference in healthcare management is appropriate depends on to what extent multimorbidity influences the outcomes of total hip replacement.

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Sex, Age, and Socioeconomic Differences in Nonfatal Stroke Incidence and Subsequent Major Adverse Outcomes

Stroke ◽

10.1161/strokeaha.120.031659 ◽

2021 ◽

Vol 52 (2) ◽

pp. 396-405

Author(s):

Ralph K. Akyea ◽

Yana Vinogradova ◽

Nadeem Qureshi ◽

Riyaz S. Patel ◽

Evangelos Kontopantelis ◽

...

Keyword(s):

Socioeconomic Status ◽

United Kingdom ◽

Adverse Outcomes ◽

Nonfatal Stroke ◽

Practice Research ◽

Major Adverse Cardiovascular Events ◽

Clinical Practice Research Datalink ◽

Socioeconomic Differences ◽

Stroke Incidence ◽

The United Kingdom

Background and Purpose: Data about variations in stroke incidence and subsequent major adverse outcomes are essential to inform secondary prevention and prioritizing resources to those at the greatest risk of major adverse end points. We aimed to describe the age, sex, and socioeconomic differences in the rates of first nonfatal stroke and subsequent major adverse outcomes. Methods: The cohort study used linked Clinical Practice Research Datalink and Hospital Episode Statistics data from the United Kingdom. The incidence rate (IR) ratio of first nonfatal stroke and subsequent major adverse outcomes (composite major adverse cardiovascular events, recurrent stroke, cardiovascular disease-related, and all-cause mortality) were calculated and presented by year, sex, age group, and socioeconomic status based on an individual’s location of residence, in adults with incident nonfatal stroke diagnosis between 1998 and 2017. Results: A total of 82 774 first nonfatal stroke events were recorded in either primary care or hospital data—an IR of 109.20 per 100 000 person-years (95% CI, 108.46–109.95). Incidence was significantly higher in women compared with men (IR ratio, 1.13 [95% CI, 1.12–1.15]; P <0.001). Rates adjusted for age and sex were higher in the lowest compared with the highest socioeconomic status group (IR ratio, 1.10 [95% CI, 1.08–1.13]; P <0.001). For subsequent major adverse outcomes, the overall incidence for major adverse cardiovascular event was 38.05 per 100 person-years (95% CI, 37.71–38.39) with a slightly higher incidence in women compared with men (38.42 versus 37.62; IR ratio, 1.02 [95% CI, 1.00–1.04]; P =0.0229). Age and socioeconomic status largely accounted for the observed higher incidence of adverse outcomes in women. Conclusions: In the United Kingdom, incidence of initial stroke and subsequent major adverse outcomes are higher in women, older populations, and people living in socially deprived areas.

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Assessing the relationship between serum potassium variability and the risk of hyperkalaemia and adverse clinical outcomes

European Heart Journal ◽

10.1093/ehjci/ehaa946.2830 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

P McEwan ◽

K Badora ◽

D Sugrue ◽

G James ◽

M Hurst ◽

...

Keyword(s):

Serum Potassium ◽

Index Date ◽

Adverse Outcomes ◽

Practice Research ◽

Major Adverse Cardiovascular Events ◽

Clinical Practice Research Datalink ◽

Funding Source ◽

Private Company ◽

Increased Risk

Abstract Background Serum potassium (SK+) is a vital electrolyte, which level is maintained by adjusting renal K+ excretion. Variability in SK+ has been linked to increased risk of mortality and other adverse clinical events in patients in intensive care and/or receiving haemodialysis, prompting a similar investigation in cardiovascular patients. Purpose To examine the effect of SK+ variability on all-cause mortality (ACM) and the incidence of major adverse cardiovascular events (MACE), comprising arrhythmia, [subsequent records of] HF, myocardial infarction, or stroke, in patients with heart failure (HF) or resistant hypertension (RHTN). Methods Patients aged ≥18 years with HF or RHTN were identified from the UK Clinical Practice Research Datalink (CPRD, primary care data) and linked Hospital Episode Statistics (HES, secondary care data). HF and RHTN were defined through READ codes recorded during the study period (2008-June 2018) or the five-year look-back period (2003–2007). Index date was set to 1st January 2008 or initial diagnosis; whichever occurred later. Mean SK+ and variability of measurements (quantified as standard deviation [SD] and each patient categorised as low or highly variable based on the median SD of the cohort), and crude incidence rates of ACM and MACE were estimated over a follow-up period from index date to event or end of follow-up (death, loss to follow-up or end of study, whichever was earlier). Results The eligible population included 317,135 RHTN patients and 84,210 HF patients with a mean follow-up of 6.37 (SD 3.06) and 5.01 (SD 3.20) years, respectively. In both cohorts, higher mean SK+ ≥5.0 mmol/L was associated with increased rates of ACM and MACE relative to a mean SK+ of 3.5–5 mmol/L (Table 1). High SK+ variability was associated with increased incidence of adverse outcomes, with rates consistently higher in the high SK+ variability group compared to low-variability patients with the same diagnosis and mean SK+ category (Table 1); all comparisons were statistically significant except for ACM in HF patients with mean SK+ ≥5 mmol/L. Conclusion Independently of mean SK+, increased variability in SK+ levels was associated with an increased rate of mortality and MACE in patients with RHTN or HF. Careful SK+ monitoring and management to maintain SK+ concentrations may improve the outcomes of patients with RHTN and HF. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): AstraZeneca

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