Heart failure & cardiomyopathiesMeta-analysis
Optimal serum potassium concentrations in heart failure: an individual patient data meta-analysis
- Individual patient data meta-analysis of randomised controlled trials
- patient-level pooled analysis
- 12 RCTs
Authors' conclusion
In HFrEF, hypokalaemia is strongly associated with worse outcomes and should be avoided. In terms of safety, the optimal serum potassium concentration in both HFrEF and HFpEF appears to be in the range 4.2-5.0 mmol/L.
Study context
- Population
- Patients with HF with reduced ejection fraction (HFrEF) or HF with preserved ejection fraction (HFpEF) enrolled in RCTs12 RCTs
- Comparison
- Baseline serum potassium categories vs ≥4.0-<4.5 mmol/L
- Outcome
- All-cause mortality
Pooled result
All-cause mortality (HFrEF)
Adjusted hazard ratio
1.49
95% CI 1.27–1.76
<3.5 mmol/L vs ≥4.0-<4.5 mmol/L
adjusted HR 1.49 (95% CI 1.27–1.76)
As reported in the abstract
Further pooled results
CV, sudden and pump failure death (HFrEF)
- Potassium <3.5 mmol/L associated with higher risk vs ≥4.0-4.5 mmol/L
Original publication
Optimal serum potassium concentrations in heart failure: an individual patient data meta-analysis. Eur Heart J. Published 28 May 2026. doi:10.1093/eurheartj/ehag341
Summarised from the published abstract; every number is checked against it