Effects of hyperkalaemia and non‐adherence to renin–angiotensin–aldosterone system inhibitor therapy in patients with heart failure in Italy: a propensity‐matched study

Abstract

Aims The aims of this study were to evaluate if the risk of cardiovascular events and all‐cause mortality was higher in the presence of hyperkalaemia (HK) in patients with heart failure (HF) treated with renin–angiotensin–aldosterone system inhibitors (RAASi), and to investigate in this cohort the increased risk of cardiovascular events and all‐cause mortality among HK patients with non‐optimal adherence to RAASi therapy. Methods and results In this retrospective cohort study based on administrative databases of five Italian Local Health Units, all adult patients with a HF diagnosis between January 2010 and December 2017 were included only if they were prescribed RAASi therapy during the first 3 months after the index date, that corresponded to the date of first HF diagnosis during the inclusion period. Patients were considered to have HK if serum potassium level was ≥5.5 mmol/L. A propensity score matching was applied before evaluation of hazard ratios. Patients with HK were 37% (P < 0.001) and 70% (P < 0.001), respectively, more at risk of cardiovascular events and of dying for all‐cause mortality compared to non‐HK patients. Among the HK group, patients non‐adherent to RAASi therapy had a 39% (P = 0.105) higher risk of cardiovascular events and a twofold increased risk (P < 0.001) of all‐cause death. Conclusion Findings from this real‐world study showed that in a cohort of HF patients under RAASi therapy, subjects with HK had an enhanced risk of cardiovascular events or death compared to patients without HK. Moreover, in HK patients, sub‐optimal adherence to RAASi therapy was associated with an increased risk of all‐cause mortality.

Stopping mineralocorticoid receptor antagonists after hyperkalaemia: trial emulation in data from routine care

“…To minimize this bias, we evaluated clinical decisions after the first hyperkalaemia episode detected among new users of MRA, and adjusted for a rich set of time‐dependent confounders. More recently, Volterrani et al 20 . observed in a cohort of patients with heart failure that 22% stopped RAASi after hyperkalaemia.…”

May 2021 at a glance: focus on acute heart failure and heart failure with preserved ejection fraction

“…Serum potassium concentration has been largely associated with outcome in patients with HF and reduced ejection fraction but not in HFpEF 19,20 . In a post‐hoc analysis of the PARAGON‐HF [Prospective Comparison of ARNI (angiotensin receptor–neprilysin inhibitor) with ARB (angiotensin‐receptor blockers) Global Outcomes in HFpEF) trial, hypo‐ and hyperkalaemia led to an increased risk of the composite endpoint of total HF hospitalizations or cardiovascular death, compared with normokalaemia (adjusted HR for hypokalaemia 1.55, 95% CI 1.30–1.85; P < 0.001, and for hyperkalaemia HR 1.21, 95% CI 1.02–1.44; P = 0.025).…”

July 2021 at a glance: focus on blood volume distribution, haemodynamics and adherence to therapy

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Strategies to improve adherence to guideline-directed medical therapy (GDMT) are needed for patients with HFrEF. [15][16][17] In 2345 patients with worsening HF from the BIOSTAT-CHF

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