@article{10902/29837,
year = {2023},
month = {8},
url = {https://hdl.handle.net/10902/29837},
abstract = {Objective
Both hyperkalemia (HK) and Acute Heart Failure (AHF) are associated with increased short-term mortality, and the management of either may exacerbate the other. As the relationship between HK and AHF is poorly described, our purpose was to determine the relationship between HK and short-term outcomes in Emergency Department (ED) AHF.

Methods
The EAHFE Registry enrolls all ED AHF patients from 45 Spanish ED and records in-hospital and post-discharge outcomes. Our primary outcome was all-cause in-hospital death, with secondary outcomes of prolonged hospitalization (>7 days) and 7-day post-discharge adverse events (ED revisit, hospitalization, or death). Associations between serum potassium (sK) and outcomes were explored using logistic regression by restricted cubic spline (RCS) curves, with sK =4.0 mEq/L as the reference, adjusting by age, sex, comorbidities, patient baseline status and chronic treatments. Interaction analyses were performed for the primary outcome.

Results
Of 13,606 ED AHF patients, the median (IQR) age was 83 (76-88) years, 54% were women, and the median (IQR) sK was 4.5 mEq/L (4.3-4.9) with a range of 4.0-9.9 mEq/L. In-hospital mortality was 7.7%, with prolonged hospitalization in 35.9%, and a 7-day post-discharge adverse event rate of 8.7%. Adjusted in-hospital mortality increased steadily from sK ≥4.8 (OR = 1.35, 95% CI = 1.01-1.80) to sK = 9.9 (8.41, 3.60-19.6). Non-diabetics with elevated sK had higher odds of death, while chronic treatment with mineralocorticoid-receptor antagonists exhibited a mixed effect. Neither prolonged hospitalization nor post-discharge adverse events was associated with sK.

Conclusion
In ED AHF, initial sK >4.8 mEq/L was independently associated with in-hospital mortality, suggesting that this cohort may benefit from aggressive HK treatment},
publisher = {Elsevier},
publisher = {American journal of emergency medicine, 2023, 70, 1-9},
title = {Hyperkalemia in acute heart failure: Short term outcomes from the EAHFE registry},
author = {Rafique, Zubaid and Fortuny, Maria José and Kuo, Dick and Szarpak, Lukasz and Llauger, Lluís and Espinosa, Begoña and Gil, Víctor and Jacob, Javier and Alquézar-Arbé, Aitor and Andueza, Juan Antonio and Garrido, José Manuel and Aguirre, Alfons and Fuentes, Marta and Alonso Valle, Héctor and Lucas-Imbernón, Francisco Javier and Bibiano, Carlos and Burillo-Putze, Guillermo and Núñez, Julio and Mullens, Wilfried and Lopez-Ayala, Pedro},
}