Heart failure & cardiomyopathies
Cardiovascular outcomes with potassium binders in patients with heart failure and hyperkalaemia
Authors' conclusion
In this observational study of HF with hyperkalaemia, potassium binders were associated with different cardiovascular outcomes. These findings are hypothesis-generating and support randomized trials powered for clinical endpoints.
Study context
- Population
- Adults with heart failure (HF) and hyperkalaemia initiating patiromer, sodium zirconium cyclosilicate (SZC), or sodium polystyrene sulfonate (SPS) (2019–2024)matched patients per group in each pairwise comparison · patiromer vs SPS, per group 5,589 · SZC vs SPS, per group 15,769 · SZC vs patiromer, per group 4,381
- Exposure
- cardiovascular outcomes associated with patiromer, sodium zirconium cyclosilicate (SZC), and sodium polystyrene sulfonate (SPS)
Methodological detailsTriNetX network, Three pairwise 1:1 propensity-matched comparisons
- TriNetX network
- Three pairwise 1:1 propensity-matched comparisons
Main finding
As reported in the abstract
Patiromer vs SPS: HF hospitalization, cardiovascular hospitalization, mortality · Follow-up up to 365 days (mean 0.7 ± 0.4 years)
patiromer vs SPSHazard ratio (95% CI)
HF hospitalization
0.573(0.535–0.613)
Cardiovascular hospitalization
0.737(0.697–0.779)
Mortality (slightly higher)
1.096(1.027–1.170)
Observational data: associations, not effects.
Further findings
| Outcome | HR (95% CI) | |
|---|---|---|
| SZC vs SPS: death, HF hospitalization, myocardial infarction, ESKD, cardiovascular hospitalization — SZC vs SPS · death · propensity-matched | 1.139 (1.095–1.185) | |
| SZC vs SPS: death, HF hospitalization, myocardial infarction, ESKD, cardiovascular hospitalization — SZC vs SPS · HF hospitalization · propensity-matched | 1.184 (1.143–1.225) | |
| SZC vs SPS: death, HF hospitalization, myocardial infarction, ESKD, cardiovascular hospitalization — SZC vs SPS · myocardial infarction · propensity-matched | 1.132 (1.018–1.260) | |
| SZC vs SPS: death, HF hospitalization, myocardial infarction, ESKD, cardiovascular hospitalization — SZC vs SPS · ESKD · propensity-matched | 1.137 (1.082–1.196) | |
| SZC vs SPS: death, HF hospitalization, myocardial infarction, ESKD, cardiovascular hospitalization — SZC vs SPS · cardiovascular hospitalization · propensity-matched | 1.193 (1.157–1.229) | |
| SZC vs patiromer: HF hospitalization, cardiovascular hospitalization, mortality — SZC vs patiromer · HF hospitalization · propensity-matched | 2.735 (2.519–2.969) | |
| SZC vs patiromer: HF hospitalization, cardiovascular hospitalization, mortality — SZC vs patiromer · cardiovascular hospitalization · propensity-matched | 1.914 (1.797–2.037) | |
| 0.20.5125Hazard ratio (log scale) |
SZC vs patiromer: HF hospitalization, cardiovascular hospitalization, mortality
- No significant difference in mortality
Original publication
Cardiovascular outcomes with potassium binders in patients with heart failure and hyperkalaemia. ESC Heart Fail. Published 28 September 2026. doi:10.
Summarised from the published abstract; every number is checked against it