Elderly patients hospitalized for acute heart failure (AHF) who have hyperkalemia at admission are at higher risk for HF readmission and mortality, according to a new study.

“Our results emphasize the importance of K+ values in elderly AHF patients and suggest that controlling K+promptly might lead to a reduction in adverse outcomes in this population,” Francesc Formiga, MD, of Hospital Universitari de Bellvitge, in Barcelona, Spain, and colleagues concluded in the European Journal of Internal Medicine.

Dr Formiga’s team evaluated 2865 patients aged older than 74 years hospitalized for AHF, classifying them according to admission serum potassium levels: above 5.5 mEq/L (hyperkalemia), 3.5–5.5 mEq/L (normokalemia), and less than 3.5 mEq/L (hypokalemia). The patients had a mean admission potassium value of 4.3 mmol/L, with 97 patients (3.38%) presenting with hyperkalemia, 2594 (90.5%) with normokalemia, and 174 (6.0%) with hypokalemia. The 3 groups did not differ significantly with respect to age and the proportion of male and female patients and patients with hypertension.

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Overall, 43 patients were readmitted for HF or died during follow-up. Compared with normokalemic patients, patients with hyperkalemia and hypokalemia had a 59% and 41% increased risk of HF readmission or death. Admission hyperkalemia was associated with a significant 67% increased risk of HF readmission and nonsignificant 43% increased risk of 1-year mortality. Admission hypokalemia was not significantly associated with either outcome.

On multivariable analysis, admission hyperkalemia was associated with a significant 15% increased risk of the combined outcome of HF readmission and 1-year mortality.


Formiga F, Chivite D, Corbella X, et al. Influence of potassium levels on one-year outcomes in elderly patients with acute heart failure. Eur J Intern Med. 2019;60:24-30.