Heart failure & cardiomyopathiesSecondary analysis
Patiromer for Heart Failure Medication Optimization in Patients With Current or Past Hyperkalemia
- Secondary analysis of the DIAMOND randomised trial
- prespecified analysis
- phase 3
- single-blind run-in
- double-blind
- placebo-controlled
- subgroup analysis (current vs past hyperkalemia)
Authors' conclusion
The use of patiromer facilitates achieving target doses of RAASis in patients with HFrEF with either current or past hyperkalemia. For those with current hyperkalemia before RAASi optimization, use of patiromer may be more beneficial in helping to maintain sK+ control and achieve MRA target dose.
Study context
- Population
- Patients with heart failure with reduced ejection fraction (HFrEF) and current or past hyperkalemiacompleted run-in
- Participants
- 1,038 patients
- Comparison
- Patiromer vs placebo, by current vs past hyperkalemia
Primary result
As reported in the abstract
Adjusted mean change in sK+ from baseline, double-blind phase
Patiromer vs PlaceboDifference in adjusted mean change (95% CI)
current hyperkalemia
−0.12(−0.17 to −0.07)
past hyperkalemia
−0.08(−0.12 to −0.05)
Further findings
| Outcome | Values | HR (95% CI) | |
|---|---|---|---|
| Maintaining MRA at target dose, by subgroup — Patiromer vs Placebo · current hyperkalemia | 0.45 (0.26–0.76) | ||
| Maintaining MRA at target dose, by subgroup — Patiromer vs Placebo · past hyperkalemia | 0.85 (0.54–1.32) | ||
| 0.20.5125Hazard ratio (log scale) |
| Outcome | Values | Estimate |
|---|---|---|
| RAASi optimization achieved and randomised, by subgroup · run-in | Current hyperkalemia 83.9% · Past hyperkalemia 85.1% |
- Maintaining MRA at target dose, by subgroup: Pinteraction = 0.031
- RAASi optimization achieved and randomised, by subgroup: of 422 current and 616 past
Safety
Adverse events
- Similar between subgroups
Original publication
Patiromer for Heart Failure Medication Optimization in Patients With Current or Past Hyperkalemia. JACC Heart Fail. Published 25 September 2024. doi:10.1016/j.jchf.2024.08.003
Summarised from the published abstract; every number is checked against it