Influence of potassium levels on one-year outcomes in elderly patients with acute heart failure

Background: Abnormal serum potassium levels (K+) in patients with heart failure (HF) relate to worse prognosis. We evaluated whether admission K+ levels predict 1-year outcomes in elderly patients admitted for acute HF. Methods: We evaluated 2865 patients aged > 74 years from the RICA Spanish Heart Failure Registry, classified according to admission serum K(+ )levels: hyperkalemia ( > 5.5 mmol/L), normokalemia (3.5-5.5 mmol/L) and hypokalemia ( < 3.5 mmol/L). We explored whether K+ levels were significantly associated with one-year allcause mortality or hospital readmission and their combination. Results: Mean admission K+ value was 4.3 +/- 0.6 mmol/L; 97 patients (3.38%) presented with hyperkalemia and 174 (6.06%) with hypokalemia. Overall, 43% of the patients died or were readmitted for HF during the follow-up period; the risk was higher for those with hyperkalemia (59% vs 41% in hypokalemic patients). The HR for one-year mortality was 1.43 (p = .073) and 1.67 for readmissions (p = .007) when K+ was > 5.5 mmol/L and 1.08 (p = .618) and 0.90 (p = .533) respectively for K+ < 3.5 mmol/L. The HR for the combined outcome was 1.59 (1.19-2.13); p = .002 in hyperkalemic patients and 0.96 (0.75-1.23); p = .751 in hypokalemic patients. Multivariate analysis showed a significant association of admission K(+)values > 5.5 mmol/L with the combined outcome of mortality and readmission (HR 1.15 [95% CI 1.04-1.27], p = .008). Conclusion: In patients hospitalized for decompensated HF, admission hyperkalemia predicts a higher mid-term risk for HF readmission and mortality, probably related to the significant higher risk of readmission.