Heart failure & cardiomyopathiesCohort study
Management of Patients with Heart Failure at High Risk of Hyperkalaemia: The CARE-HK in Heart Failure (HF) Registry
- Prospective registry study
- multinational
Authors' conclusion
In this contemporary multinational prospective registry of patients with HF at high risk for hyperkalaemia, hyperkalaemic events were common but infrequently associated with RASi/MRA modification or potassium binder use. Fewer than one in three patients received optimal RASi/MRA therapy for the majority of follow-up, and hyperkalaemic events were associated with higher risk of adverse clinical outcomes.
Study context
- Population
- Outpatients with HF (any LVEF) on ACEi/ARB/ARNI, receiving or candidate for mineralocorticoid receptor antagonist (MRA), at increased risk of hyperkalaemia (baseline or prior hyperkalaemia, or estimated glomerular filtration rate (eGFR) <45 ml/min/1.73 m²)111 sites, nine countries
- Participants
- 2,558 outpatients
- Exposure
- Hyperkalaemic event vs no hyperkalaemic event
Main finding
As reported in the abstract
Patients with a hyperkalaemic event
29%
Patients with multiple events
7%
Observational data: associations, not effects.
Further findings
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| All-cause mortality | 1.22 (0.92–1.62) | P = 0.16 | |
| Subsequent hospitalization | 1.59 (1.35–1.86) | P < 0.001 | |
| 0.512Hazard ratio (log scale) |
Renin-angiotensin system inhibitor (RASi)/MRA therapy for most of follow-up
- Optimal RASi/MRA therapy
- 29%
- Suboptimal RASi/MRA therapy
- 69%
- No RASi/MRA
- 3%
RASi/MRA down-titrated or discontinued within 30 days of first hyperkalaemic event
- Cases
- 3.6%
Potassium binder use
- Patiromer
- 9.1%
- Sodium zirconium cyclosilicate
- 5.9%
Original publication
Summarised from the published abstract; every number is checked against it