Heart failure & cardiomyopathies
Hyperkalaemia as a Cause of Undertreatment with Mineralocorticoid Receptor Antagonists in Heart Failure
Authors' conclusion
Hyperkalaemia increased significantly during up-titration of GDMT but with varying magnitudes in different clinical phenotypes, which might explain why physicians refrain from prescribing MRAs to patients with HFrEF.
Study context
- Population
- Patients hospitalised for new-onset Heart Failure with Reduced Ejection Fraction (HFrEF), Sahlgrenska University Hospital, Sweden, 2016–2019of 3456 hospitalised for HF
- Participants
- 630 patients
- Exposure
- Mineralocorticoid receptor antagonist (MRA) treatment patterns during guideline-directed medical therapy (GDMT) up-titration
- Outcome
- Incidence of hyperkalaemia during up-titration of GDMT
- Follow-up
- 6 months
Methodological detailssingle-centre
- Single-centre
Main finding
As reported in the abstract
Hyperkalaemia (baseline to 6 months)
| Group | Value | Baseline |
|---|---|---|
| MRA dose reduction | 54.5% | 6.8% |
| MRA discontinuation | 50.9% | 8.8% |
| Stable MRA | 10% | 5 |
| MRA naive | 28% | 6 |
Value
MRA dose reduction54.5%
MRA discontinuation50.9%
Stable MRA10%
MRA naive28%
Baseline
MRA dose reduction6.8%
MRA discontinuation8.8%
Stable MRA5
MRA naive6
- Overall hyperkalaemia increased from 5.9 to 24.4%
- P < 0.0001
- Increase within each group
- all P < 0.0001
Observational data: associations, not effects.
Further findings
MRA use after up-titration of GDMT
- Patients receiving MRAs
- 48.4%
Potassium categories, MRA naive · 6 months
- Normokalaemia/hypokalaemia at baseline
- 87.5%
- Normokalaemia/hypokalaemia at 6 months
- 47.8%
- Mild hyperkalaemia
- 22.4%
- Moderate hyperkalaemia
- 5.7%
- Severe hyperkalaemia
- 0.9%
Characteristics of patients without MRA
- Older
- P < 0.0001
- Lower EF
- P = 0.022
- Higher NTproBNP
- P = 0.017
- Lower eGFR
- P = 0.001
- More often treated with ACEi/ARB/ARNI
- all P < 0.0001
Original publication
Hyperkalaemia as a Cause of Undertreatment with Mineralocorticoid Receptor Antagonists in Heart Failure. ESC Heart Fail. Published 25 September 2022. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →