Abstract 13939: Incidence Rate of Hyperkalemia-related Hospitalization After Initiation of a Mineralocorticoid Receptor Antagonist in Patients with Heart Failure
Background: Several clinical trials have demonstrated that mineralocorticoid receptor antagonists (MRA) markedly reduce morbidity and mortality in patients with heart failure (HF) with reduced ejection fraction. Despite their benefits, MRAs are associated with hyperkalemia potentially leading to hospitalization. The ACC/AHA guidelines recommend monitoring of serum potassium at 3, 7, 30, 60 and 90 days after initiation of MRA.
Methods: We identified patients in the Veterans Health Care System from 2003 to 2013, with a diagnosis of HF who were started on an MRA. The incidence of hospitalization for hyperkalemia was measured at 3 days, 7 days, 14 days, 30 days, 60 days, 90 days and 1 year after the initiation of an MRA.
Results: There were 179,541 patients identified with a diagnosis of HF and started on an MRA. Baseline characteristics for the patients included a mean age of 69.5 ±11.4, 98% male, 17% black, 48% with diabetes and 83% with hypertension. HF-related medications included a beta-blocker in 47%, an ACE inhibitor in 54%, ARB in 13%, and a loop diuretic in 58%. The baseline mean creatinine was 1.35±0.9 mg/dl. The incidence rate of hospitalization for hyperkalemia per 10,000 persons per month was 1.7 at 3 days, 3.3 at 7 days, 6.5 at 14 days, 8.3 at 30 days, 7.9 at 60 days, 6.6 at 90 days and 3.7 at 1 year. For those taking an ACEi or ARB (high risk group, n=113,678, 63.3%), the incidence rate was 0.9 at 3 days, 3.4 at 7 days, 7.4 at 14 days, 10.1 at 30 days, 10.1 at 60 days, 8.3 at 90 days and 4.7 days at 1 year. The prevalence of moderate hyperkalemia (k ≥ 5.5) among 65,641 monitored within 14 days after MRA initiation was 7.1% and that of severe hyperkalemia (k ≥ 6.0) among 85,220 monitored within 30 days after MRA initiation was 3.2%.
Conclusions: The incidence rate of hospitalization for hyperkalemia in this study peaked at 30 days after MRA initiation but was very low overall. Future studies to optimize the frequency of monitoring, while maintaining low rates of serious hyperkalemia may be warranted.
Author Disclosures: V.R. Chauhan: None. S. Dev: None. M. Pham: None. S. Lin: None. P. Heidenreich: None.
- © 2014 by American Heart Association, Inc.