Dataset Information

Short-term mortality risk of serum potassium levels in acute heart failure following myocardial infarction.

ABSTRACT:

Aims

Diuretic treatment is often needed in acute heart failure following myocardial infarction (MI) and carries a risk of abnormal potassium levels. We examined the relation between different levels of potassium and mortality.

Methods and results

From Danish national registries we identified 2596 patients treated with loop diuretics after their first MI episode where potassium measurement was available within 3 months. All-cause mortality was examined according to seven predefined potassium levels: hypokalaemia <3.5 mmol/L, low normal potassium 3.5-3.8 mmol/L, normal potassium 3.9-4.2 mmol/L, normal potassium 4.3-4.5 mmol/L, high normal potassium 4.6-5.0 mmol/L, mild hyperkalaemia 5.1-5.5 mmol/L, and severe hyperkalaemia: >5.5 mmol/L. Follow-up was 90 days and using normal potassium 3.9-4.2 mmol/L as a reference, we estimated the risk of death with a multivariable-adjusted Cox proportional hazard model. After 90 days, the mortality rates in the seven potassium intervals were 15.7, 13.6, 7.3, 8.1, 10.6, 15.5, and 38.3%, respectively. Multivariable-adjusted risk for death was statistically significant for patients with hypokalaemia [hazard ratio (HR): 1.91, confidence interval (95%CI): 1.14-3.19], and mild and severe hyperkalaemia (HR: 2, CI: 1.25-3.18 and HR: 5.6, CI: 3.38-9.29, respectively). Low and high normal potassium were also associated with increased mortality (HR: 1.84, CI: 1.23-2.76 and HR: 1.55, CI: 1.09-2.22, respectively).

Conclusion

Potassium levels outside the interval 3.9-4.5 mmol/L were associated with a substantial risk of death in patients requiring diuretic treatment after an MI.

SUBMITTER: Krogager ML

PROVIDER: S-EPMC4900739 | biostudies-literature | 2015 Oct

REPOSITORIES: biostudies-literature

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Publications

Short-term mortality risk of serum potassium levels in acute heart failure following myocardial infarction.

Krogager Maria Lukács ML Eggers-Kaas Lotti L Aasbjerg Kristian K Mortensen Rikke Nørmark RN Køber Lars L Gislason Gunnar G Torp-Pedersen Christian C Søgaard Peter P

European heart journal. Cardiovascular pharmacotherapy 20150527 4

<h4>Aims</h4>Diuretic treatment is often needed in acute heart failure following myocardial infarction (MI) and carries a risk of abnormal potassium levels. We examined the relation between different levels of potassium and mortality.<h4>Methods and results</h4>From Danish national registries we identified 2596 patients treated with loop diuretics after their first MI episode where potassium measurement was available within 3 months. All-cause mortality was examined according to seven predefined ...[more]

PMID: 27418967

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Project description:Importance:Hospitals in the United States have been subject to mandatory public reporting of mortality rates for acute myocardial infarction (AMI) and heart failure (HF) since 2007 and to value-based payment programs for these conditions since 2011. However, whether hospitals with initially poor baseline performance have improved relative to other hospitals under these programs, and whether patterns of improvement differ by condition, is unknown. Understanding trends within public reporting and value-based payment can inform future efforts in these areas. Objective:To examine patterns in 30-day mortality from AMI and HF and determine whether they differ for baseline poor performers (worst quartile in 2009 and 2010 in public reporting, prior to value-based payment) compared with other hospitals. Design, Setting, and Participants:Retrospective cross-sectional study at US acute care hospitals from 2009 to 2015 that included 2751 and 3796 hospitals with publicly reported mortality data for AMI and HF, respectively. Exposures:Public reporting and value-based purchasing. Main Outcomes and Measures:Hospital-level risk-adjusted 30-day mortality rates. Results:We identified 422 and 600 baseline poor-performing hospitals for AMI and HF, respectively. Baseline poor performers for AMI were more often public and for-profit and less often teaching hospitals. Baseline poor performers for HF were less often large hospitals. For AMI, 30-day mortality among baseline poor performers was higher at baseline but improved more over time compared with other hospitals (18.6% in 2009 to 14.6% in 2015; -0.74% per year; P?<?.001 vs 15.7% in 2009 to 14.0% in 2015; -0.26% per year; P?<?.001; P for interaction <.001). In contrast, for HF, baseline poor performers improved over time (13.5%-13.0%; -0.12% per year; P?<?.001), but mean mortality among all other HF hospitals increased during the study period (10.9%-12.0%; 0.17% per year; P?<?.001; P for interaction, <.001). Conclusions and Relevance:Despite being subject to identical policy pressures, mortality trends for AMI and HF differed markedly between 2009 and 2015.

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Dataset Information

Short-term mortality risk of serum potassium levels in acute heart failure following myocardial infarction.

Aims

Methods and results

Conclusion

Publications

Short-term mortality risk of serum potassium levels in acute heart failure following myocardial infarction.

Similar Datasets

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