Unravelling the interplay between hyperkalaemia, renin–angiotensin–aldosterone inhibitor use and clinical outcomes. Data from 9222 chronic heart failure patients of the ESC-HFA-EORP Heart Failure Long-Term Registry

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Ερευνητικό υλικό ΕΚΠΑ
Τίτλος:
Unravelling the interplay between hyperkalaemia, renin–angiotensin–aldosterone inhibitor use and clinical outcomes. Data from 9222 chronic heart failure patients of the ESC-HFA-EORP Heart Failure Long-Term Registry
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Αγγλικά
Περίληψη:
Aims: We assessed the interplay between hyperkalaemia (HK) and renin–angiotensin–aldosterone system inhibitor (RAASi) use, dose and discontinuation, and their association with all-cause or cardiovascular death in patients with chronic heart failure (HF). We hypothesized that HK-associated increased death may be related to RAASi withdrawal. Methods and results: The ESC-HFA-EORP Heart Failure Long-Term Registry was used. Among 9222 outpatients (HF with reduced ejection fraction: 60.6%, HF with mid-range ejection fraction: 22.9%, HF with preserved ejection fraction: 16.5%) from 31 countries, 16.6% had HK (≥5.0 mmol/L) at baseline. Angiotensin-converting enzyme inhibitor (ACEi) or angiotensin receptor blocker (ARB) was used in 88.3%, a mineralocorticoid receptor antagonist (MRA) in 58.7%, or a combination in 53.2%; of these, at ≥50% of target dose in ACEi: 61.8%; ARB: 64.7%; and MRA: 90.3%. At a median follow-up of 12.2 months, there were 789 deaths (8.6%). Both hypokalaemia and HK were independently. associated with higher mortality, and ACEi/ARB prescription at baseline with lower mortality. MRA prescription was not retained in the model. In multivariable analyses, HK at baseline was independently associated with MRA non-prescription at baseline and subsequent discontinuation. When considering subsequent discontinuation of RAASi (instead of baseline use), HK was no longer found associated with all-cause deaths. Importantly, all RAASi (ACEi, ARB, or MRA) discontinuations were strongly associated with mortality. Conclusions: In HF, hyper- and hypokalaemia were associated with mortality. However, when adjusting for RAASi discontinuation, HK was no longer associated with mortality, suggesting that HK may be a risk marker for RAASi discontinuation rather than a risk factor for worse outcomes. © 2020 European Society of Cardiology
Έτος δημοσίευσης:
2020
Συγγραφείς:
Rossignol, P.
Lainscak, M.
Crespo-Leiro, M.G.
Laroche, C.
Piepoli, M.F.
Filippatos, G.
Rosano, G.M.C.
Savarese, G.
Anker, S.D.
Seferovic, P.M.
Ruschitzka, F.
Coats, A.J.S.
Mebazaa, A.
McDonagh, T.
Sahuquillo, A.
Penco, M.
Maggioni, A.P.
Lund, L.H.
Christopher Peter Gale, G.B.
Branko Beleslin, R.S.
Andrzej Budaj, P.L.
Ovidiu Chioncel, R.O.
Nikolaos Dagres, D.E.
Nicolas Danchin, F.R.
David Erlinge, S.E.
Jonathan Emberson, G.B.
Michael Glikson, I.L.
Alastair Gray, G.B.
Meral Kayikcioglu, T.R.
Aldo Maggioni, I.T.
Klaudia Vivien Nagy, H.U.
Aleksandr Nedoshivin, R.U.
Anna-Sonia Petronio, I.T.
Jolien Roos-Hesselink, N.L.
Lars Wallentin, S.E.
Uwe Zeymer, D.E.
Anker, S.
Mebazaa, A.
Coats, A.
Filippatos, G.
Ferrari, R.
Maggioni, A.P.
Goda, A.
Diez, M.
Fernandez, A.
Fruhwald, F.
Fazlibegovic, E.
Gatzov, P.
Kurlianskaya, A.
Hullin, R.
Christodoulides, T.
Hradec, J.
Nielsen, O.W.
Nedjar, R.
Uuetoa, T.
Hassanein, M.
Jimenez, J.F.D.
Harjola, V.P.
Logeart, D.
Chumburidze, V.
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Milicic, D.
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Shotan, A.
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Metra, M.
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Fonseca, C.
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Subias, P.E.
Hernandez, M.V.
Cano, M.J.R.
Sanchez, M.A.G.
Jimenez, J.F.D.
Garrido-Lestache, E.B.
Pinilla, J.M.G.
de la Villa, B.G.
Sahuquillo, A.
Marques, R.B.
Calvo, F.T.
Perez-Martinez, M.T.
Gracia-Rodenas, M.R.
Garrido-Bravo, I.P.
Pastor-Perez, F.
Pascual-Figal, D.A.
Molina, B.D.
Orus, J.
Gonzalo, F.E.
Bertomeu, V.
Valero, R.
Martinez-Abellan, R.
Quiles, J.
Rodrigez-Ortega, J.A.
Mateo, I.
ElAmrani, A.
Fernandez-Vivancos, C.
Valero, D.B.
Almenar-Bonet, L.
Sanchez-Lazaro, I.J.
Marques-Sule, E.
Facila-Rubio, L.
Perez-Silvestre, J.
Garcia-Gonzalez, P.
Ridocci-Soriano, F.
Garcia-Escriva, D.
Pellicer-Cabo, A.
de la Fuente Galan, L.
Diaz, J.L.
Platero, A.R.
Arias, J.C.
Blasco-Peiro, T.
Julve, M.S.
Sanchez-Insa, E.
Aured-Guallar, C.
Portoles-Ocampo, A.
Melin, M.
Hägglund, E.
Stenberg, A.
Lindahl, I.-M.
Asserlund, B.
Olsson, L.
Dahlström, U.
Afzelius, M.
Karlström, P.
Tengvall, L.
Olsson, B.
Kalayci, S.
Temizhan, A.
Cavusoglu, Y.
Gencer, E.
Yilmaz, M.B.
Gunes, H.
Περιοδικό:
European Journal of Heart Failure
Εκδότης:
John Wiley and Sons Ltd
Τόμος:
22
Αριθμός / τεύχος:
8
Σελίδες:
1378-1389
Λέξεις-κλειδιά:
angiotensin receptor antagonist; dipeptidyl carboxypeptidase inhibitor; mineralocorticoid antagonist; aldosterone; angiotensin derivative; angiotensin receptor antagonist; dipeptidyl carboxypeptidase inhibitor; mineralocorticoid antagonist; renin, adult; aged; all cause mortality; Article; cardiovascular mortality; clinical outcome; controlled study; disease association; disease registry; drug use; drug withdrawal; female; follow up; heart failure; heart failure with preserved ejection fraction; heart failure with reduced ejection fraction; human; hyperkalemia; low drug dose; major clinical study; male; middle aged; observational study; outcome assessment; outpatient; prescription; priority journal; risk assessment; risk factor; systolic blood pressure; treatment withdrawal; heart failure; hyperkalemia; register, Aldosterone; Angiotensin Receptor Antagonists; Angiotensin-Converting Enzyme Inhibitors; Angiotensins; Heart Failure; Humans; Hyperkalemia; Mineralocorticoid Receptor Antagonists; Registries; Renin
Επίσημο URL (Εκδότης):
DOI:
10.1002/ejhf.1793
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