scholarly journals Incidence and determinants of hyperkalemia among heart failure patients who used spironolactone

2021 ◽  
Author(s):  
Majed Nahari ◽  
Anas Aldawsari ◽  
Zuhair Alqahtani ◽  
Meshary Almeshary
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Beta Blockers ◽  
Retrospective Chart Review ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Data Sampling ◽  
Angiotensin Ii Receptor ◽  
Converting Enzyme Inhibitors ◽  
Heart Failure Patients ◽  
The Mean

Abstract Background Potassium balance in heart failure is affected by many factors including neurohormonal mechanisms and drugs used in its management. Renin–angiotensin–aldosterone system inhibitor therapies are part of heart failure therapy and have been associated with increase the risk of hyperkalemia. Currently, there are limited data on the prevalence and risk factors of hyperkalemia in heart failure patients who received spironolactone as an add-on to standard therapy which include Angiotensin-Converting Enzyme Inhibitors (ACEIs) or Angiotensin II receptor blockers (ARBs). The objective of this study is to identify Incidence and determine of hyperkalemia risk factors among heart failure patients who have been using spironolactone. Methods This is a retrospective chart review, from March 1, 2016 to March 31, 2019 conducted at King Abdulaziz Medical City-Riyadh. All heart failure patients with age more than 18 year who are using spironolactone were included and we excluded if they had any of the following criteria: (1) end stage renal disease on dialysis; (2) cancer; (3) history of hyperkalemia. A data collection sheet was used to collect demographics (e.g., age, gender, weight, ejection fraction, and baseline potassium), comorbidities (e.g., chronic kidney disease, and diabetes), visit history (dose of spironolactone, hyperkalemia incidence, time to the event, medication that was patient on include (ACEI, ARB, digoxin, furosemide, beta-blockers, and potassium supplements), average potassium level, average creatinine, and average BNP). An Excel-based tool (Microsoft® Excel; Version 2018) was used for systematic data sampling and analysis. The study was approved by Institutional Review Board. Results A total of 349 patients met the inclusion criteria. 43% of patients were men while 57% were women. The mean age of patients was 64.87 ± 14.02 years. The mean baseline of potassium before start spironolactone were 4.34 ± 3.45 mmol/L. Hyperkalemia were assessed with different dose of spironolactone (12.5 mg, 25 mg, 50 mg). 161 patients were received 12.5 mg spironolactone, 40% of those patients who had incidence of hyperkalemia. 62% of those who developed hyperkalemia were on ACEI, 28% on ARB, 14% on potassium supplements. 263 patients were received 25 mg spironolactone, 47% of patients had incidence of hyperkalemia. 49% of those who developed hyperkalemia were on ACEI, 31% on ARB, and 22% on potassium supplements. 17 patients were received 50 mg spironolactone, 53% of patients had incidence of hyperkalemia. 44% of those who developed hyperkalemia were on ACEI, 22% on ARB, and 22% on potassium supplements. Conclusion Our study showed that half of heart failure patients who used spironolactone developed hyperkalemia. The majority of patients who developed hyperkalemia were either on ACEIs or ARBs. Spironolactone dosing of 50 mg was associated with highest incidence of hyperkalemia. Further study with a larger sample size is required to clarify and confirm our study findings.

Discontinuation of angiotensin-converting enzyme inhibitors or beta-blockers and the impact on heart failure hospitalization rates

2019 ◽  
Vol 18 (8) ◽  
pp. 667-678
Author(s):  
George J Knafl ◽  
Debra K Moser ◽  
Jia-Rong Wu ◽  
Barbara Riegel
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Angiotensin Converting Enzyme ◽  
Electronic Monitoring ◽  
Enzyme Inhibitors ◽  
Beta Blockers ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Converting Enzyme Inhibitors ◽  
Heart Failure Patients ◽  
Hospitalization Rates

Background: Adherence to evidence-based therapy is essential for optimal management of heart failure. Yet, medication adherence is poor in heart failure patients. The Ascertaining Barriers to Compliance Project decomposed the medication adherence process into initiation, implementation, and discontinuation stages, but electronic monitoring-based adherence analyses usually do not consider this process. Aims: The aim of this study was to describe individual-patient patterns of medication adherence from electronic monitoring data among adults with chronic heart failure, adherence types, and risk factors for increased all-cause hospitalization including measures of poor adherence such as discontinuation. Methods: Data from two prospective studies of adherence measured with electronic monitoring for heart failure patients were combined and restricted to monitoring of angiotensin-converting enzyme inhibitors and beta-blockers over an initial three-month period. Hospitalizations were recorded for this period as well as for a three-month follow-up period. Analyses were conducted using adaptive modeling methods to identify individual-patient adherence patterns, adherence types, and risk factors for an increased hospitalization rate. Results: Using electronic monitoring data for 254 heart failure patients, four adherence types were identified: highly consistent, consistent but variable, moderately consistent, and poorly consistent. Sixteen individually significant risk factors for increased hospitalization rates were identified and used to generate a multiple risk factors model. Medication discontinuation was the most important individual risk factor and most important in the multiple risk factors model. Conclusion: Discontinuation of angiotensin-converting enzyme inhibitors or beta-blockers increases hospitalization rates for heart failure patients. Interventions that effectively address this problem are urgently needed.

Abstract 11815: Effects of Angiotensin-Converting Enzyme Inhibitors, Angiotensin II Receptor Blockers and Beta-Blockers on the Prevention of Atrial Fibrillation in Patients With Heart Failure With Preserved Ejection Fraction: A Prospective Study of Four-Years Follow-Up

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Masanori Kawasaki ◽  
Ryuhei Tanaka ◽  
Shingo Minatoguchi ◽  
Takatomo Watanabe ◽  
Maki Saeki ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Diastolic Dysfunction ◽  
Enzyme Inhibitors ◽  
Beta Blockers ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Angiotensin Ii Receptor ◽  
Converting Enzyme Inhibitors ◽  
Significant Difference ◽  
New Onset

Background: The incidence of new-onset atrial fibrillation (AF) is increasing with the prevalence of diastolic dysfunction. Diastolic dysfunction is thought to be responsible for heart failure with preserved ejection fraction (HFPEF). Effective medication for the treatment of HFPEF has been controversial, although angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptor blockers (ARBs) and beta-blockers (BBs) have been proven to be effective in heart failure with reduced EF. We recently reported that pulmonary capillary wedge pressure (ePCWP) estimated by the combination of left atrial (LA) volume (V) and emptying function (EF) evaluated by speckle tracking echocardiography (STE) had a strong correlation with PCWP measured by cardiac catheterization (r=0.86-0.92). Methods: We screened 663 elderly (>65 years old) patients and identified 228 who had no AF history and met the criteria for diastolic dysfunction according to the Echocardiography Association of the European Society of Cardiology. These patients were prospectively followed for 4 years to identify new-onset AF. We measured echocardiographic parameters such as left ventricular (LV) mass index, LV ejection fraction, E/A, E/e’ and ePCWP at baseline. Concomitant medication was left to the discretion of the physicians in charge. Results: During a mean follow-up of 43 months, 63 elderly patients (age 73±6, 39 men) developed electrocardiographically-confirmed AF. There was no significant difference in the development of new-onset AF between the groups treated with and without BBs (hazard ratio (HR): 0.615, p=0.15). There was also no significant difference in new-onset AF between the groups with and without ACEIs or ARBs (HR: 0.796, p=0.46). However, in multivariate analysis that included ePCWP, LVM index, E/e’ and E/A, ePCWP at baseline independently predicted the risk of new-onset AF (HR: 1.42, 95% confidence interval: 1.29-1.57, p<0.001). Conclusions: ACEIs, ARBs or BBs had no beneficial effects on the prevention of new-onset AF as a marker of diastolic dysfunction in the patients with HFPEF. Estimation of ePCWP by STE had incremental value for the risk stratification of new-onset AF.

Heart failure

2012 ◽  
Keyword(s):  
Heart Failure ◽  
Angiotensin Ii ◽  
Enzyme Inhibitors ◽  
Beta Blockers ◽  
Signs And Symptoms ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Converting Enzyme ◽  
Angiotensin Ii Receptor ◽  
Angiotensin Ii Receptor Antagonists ◽  
Converting Enzyme Inhibitors

Introduction 368Forms of heart failure 370Causes and precipitants 372Signs and symptoms 374Investigations 378Management of heart failure 382Diuretics in heart failure 386Angiotensin-converting enzyme inhibitors for heart failure 390Angiotensin II receptor antagonists for heart failure 392Beta-blockers for heart failure ...

Epidemiology of gout

2016 ◽  
Author(s):  
Samantha Hider ◽  
Edward Roddy
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Beta Blockers ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Epidemiological Studies ◽  
Dietary Factors ◽  
Angiotensin Ii Receptor ◽  
Converting Enzyme Inhibitors ◽  
Increased Risk

Gout is the most prevalent inflammatory arthritis in men. Data from epidemiological studies conducted in several countries suggest that the prevalence and incidence of gout have risen over the last few decades, although incidence may have stabilized recently. Dietary factors (animal purines, alcohol, and fructose), co-morbid medical conditions (obesity, metabolic syndrome, hypertension, and chronic kidney disease), and medications (diuretics, aspirin, beta blockers, angiotensin converting-enzyme inhibitors, and non-losartan angiotensin II receptor blockers) have been confirmed to be risk factors for both hyperuricaemia and gout. In contrast, low-fat dairy products, coffee, vitamin C, calcium channel antagonists, and losartan appear to reduce the risk of developing gout. People with gout are themselves at increased risk of developing cardiovascular disease and chronic kidney disease, independent of traditional risk factors for these conditions.

The Use of Angiotensin-II Receptor Blockers in Heart Failure

2002 ◽  
Vol 15 (4) ◽  
pp. 318-325
Author(s):  
Jodie M. Fink
Keyword(s):  
Heart Failure ◽  
Angiotensin Ii ◽  
Enzyme Inhibitors ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Angiotensin Ii Receptor Blockers ◽  
Angiotensin Ii Receptor ◽  
Converting Enzyme Inhibitors ◽  
Heart Failure Patients ◽  
Patients With Heart Failure ◽  
Receptor Blockers

Angiotensin-II receptor blockers (ARBs) have recently been evaluated in large trials to determine their role in the treatment of heart failure. It is clear that angiotensin-converting enzyme inhibitors (ACE-Is) prevent the effects of an overactive renin-angiotensin aldosterone system and therefore prevent disease progression. Despite this evidence, intolerance (eg, cough) limits the use of ACE-Is in heart failure patients. Improved tolerability makes ARBs attractive alternatives in patients intolerant to ACE-Is. ARBs are also hypothesized to have additional benefits when used in combination with ACE-Is through more complete inhibition of angiotensin-II. However, studies of ARBs in patients with heart failure have not confirmed this hypothesis. This article describes the rationale and evaluates the literature for the use of ARBs in heart failure.

scholarly journals Phenotypic clusters in heart failure with preserved and mid-range ejection fraction: new data and perspectives

2021 ◽  
Vol 26 (4) ◽  
pp. 4436
Author(s):  
O. V. Tsygankova ◽  
V. V. Veretyuk
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Beta Blockers ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Evidence Base ◽  
Angiotensin Ii Receptor ◽  
Converting Enzyme Inhibitors ◽  
Reduced Ejection Fraction ◽  
Neprilysin Inhibitor ◽  
The Impact

The problems of heart failure (HF) are becoming increasingly important every year due to the increasing spread of cardiovascular diseases resulting in its development, as well as the impact of metabolic factors, obesity, drugs and endocrine dysfunctions on the myocardium. Isolation of phenotypes with preserved, mid-ranged and reduced ejection fraction in HF allows ranking the evidence base and identifying groups of patients with preferred drug intervention strategies aimed at achieving the six goals of treating HF patients and, above all, reducing mortality. The results of recent studies have significantly expanded the list of tools for management of HF with reduced ejection fraction (EF), presented today, according to John J. V. McMurray, by five pillars: angiotensin-converting enzyme inhibitors or angiotensin-II receptor blockers, angiotensin receptor antagonist/neprilysin inhibitor, beta-blockers, mineralocorticoid receptor antagonists, sodium-glucose cotransporter 2 (SGLT2). On the other hand, the exceptional heterogeneity of patients with HF with preserved and mid-range EF and a prevailing opinion on the need for a unified therapy for patients with HF with mid-range and reduced EF, along with the absence of proven prognosis-modifying drugs, require the identifying phenotypic clusters of patients for targeted selection of a treatment strategy. This was the subject of interest in this literature review.

scholarly journals Medical therapy in patients with thoracic aortic aneurism

2018 ◽  
Vol 24 (3) ◽  
pp. 264-271
Author(s):  
E. B. Luneva ◽  
E. G. Malev ◽  
I. A. Pankova ◽  
E. V. Zemtsovsky
Keyword(s):  
Thoracic Aorta ◽  
Enzyme Inhibitors ◽  
Beta Blockers ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Angiotensin Ii Receptor ◽  
Converting Enzyme Inhibitors ◽  
Medication Therapy ◽  
First Line Therapy ◽  
Receptor Blockers ◽  
Aorta Diameter

Aneurysm of the thoracic aorta of any origin is traditionally considered a pathology for surgical correction. Traditionally the patients are referred for the surgery (prosthetics or endovascular treatment) when thoracic aorta diameter achieves 50–55 mm. However, the management strategy and conservative treatment in case of the smaller aorta dilations are not well elucidated in еру guidelines. The medication therapy aims at the decrease of the hemodynamic stress in the aortic wall, as well as at the correction of risk factors and accompanying diseases, including coronary heart disease, diabetes mellitus, hypertension, etc. Since drug therapy of this pathology is not sufficiently developed, its choice is difficult for physicians. The paper reviews the main groups of drugs and their effectiveness in patients with thoracic aorta aneurism resulted from different causes, including atherosclerosis, genetic pathology (Marfan syndrome, Loeys-Dietz syndrome, etc.). Currently, no drugs are considered as first line therapy. The evidence suggests the use of beta-blockers, angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers only in genetic pathology.

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