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Bosch L, Minneboo M, Baggen VJM, Beusekamp JC, Yilmaz D, Haroun D, Vorselaars VMM, Meijers WC. Career perspectives for young cardiologists in the Netherlands: an update. Neth Heart J 2023; 31:454-455. [PMID: 37707766 PMCID: PMC10602970 DOI: 10.1007/s12471-023-01816-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2023] [Indexed: 09/15/2023] Open
Affiliation(s)
- Lena Bosch
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands.
| | - Madelon Minneboo
- Department of Cardiology, Amsterdam University Medical Centre, location Academic Medical Centre, Amsterdam, The Netherlands
| | - Vivan J M Baggen
- Department of Cardiology, Erasmus Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Joost C Beusekamp
- Department of Cardiology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Dilek Yilmaz
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Dany Haroun
- Department of Cardiology, Medisch Spectrum Twente, Enschede, The Netherlands
| | | | - Wouter C Meijers
- Department of Cardiology, Erasmus Medical Centre Rotterdam, Rotterdam, The Netherlands
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2
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Voorrips SN, Boorsma EM, Beusekamp JC, DE-Boer RA, Connelly MA, Dullaart RPF, VAN-DER-Meer P, VAN-Veldhuisen DJ, Voors AA, Damman K, Westenbrink BD. Longitudinal Changes in Circulating Ketone Body Levels in Patients With Acute Heart Failure: A Post Hoc Analysis of the EMPA-Response-AHF Trial. J Card Fail 2023; 29:33-41. [PMID: 36244653 DOI: 10.1016/j.cardfail.2022.09.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 09/13/2022] [Accepted: 09/13/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Ketone bodies are endogenous fuels produced by the liver under conditions of metabolic or neurohormonal stress. Circulating ketone bodies are increased in patients with chronic heart failure (HF), yet little is known about the effect of acute HF on ketosis. We tested the hypothesis that ketogenesis is increased in patients with acute decompensated HF. METHODS AND RESULTS This was a post hoc analysis of 79 patients with acute HF included in the EMPA-RESPONSE-AHF trial, which compared sodium-dependent glucose-cotransporter protein 2 inhibitor treatment with empagliflozin for 30 days with placebo in patients with acute HF [NCT03200860]. Plasma concentrations of ketone bodies acetone, β-hydroxybutyrate, and acetoacetate were measured at baseline and 5 different timepoints. Changes in ketone bodies over time were monitored using repeated measures analysis of variance. In the total cohort, median total ketone body concentration was 251 µmol/L (interquartile range, 178-377 µmol/L) at baseline, which gradually decreased to 202 µmol/L (interquartile range, 156-240 µmol/L) at day 30 (P = .041). Acetone decreased from 60 µmol/L (interquartile range, 34-94 µmol/L) at baseline to 30 µmol/L (interquartile range, 21-42 µmol/L) ( P < .001), whereas β-hydroxybutyrate and acetoacetate remained stable over time. Higher acetone concentrations were correlated with higher N-terminal pro brain natriuretic peptide levels (r = 0.234; P = .039). Circulating ketone bodies did not differ between patients treated with empagliflozin or placebo throughout the study period. A higher acetone concentration at baseline was univariately associated with a greater risk of the composite end point, including in-hospital worsening HF, HF rehospitalizations, and all-cause mortality after 30 days. However, after adjustment for age and sex, acetone did not remain an independent predictor for the combined end point. CONCLUSIONS Circulating ketone body concentrations, and acetone in particular, were significantly higher during an episode of acute decompensated HF compared with after stabilization. Treatment with empagliflozin did not affect ketone body concentrations in patients with acute HF.
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Affiliation(s)
- S N Voorrips
- Department of Cardiology, University of Groningen, University Medical Center Groningen (UMCG), Groningen, the Netherlands
| | - E M Boorsma
- Department of Cardiology, University of Groningen, University Medical Center Groningen (UMCG), Groningen, the Netherlands
| | - J C Beusekamp
- Department of Cardiology, University of Groningen, University Medical Center Groningen (UMCG), Groningen, the Netherlands
| | - R A DE-Boer
- Department of Cardiology, University of Groningen, University Medical Center Groningen (UMCG), Groningen, the Netherlands; Department of Cardiology, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - M A Connelly
- Laboratory Corporation of America Holdings (Labcorp), Morrisville, North Carolina; and the
| | - R P F Dullaart
- Department of Internal Medicine, University Medical Center Groningen (UMCG), Groningen, the Netherlands
| | - P VAN-DER-Meer
- Department of Cardiology, University of Groningen, University Medical Center Groningen (UMCG), Groningen, the Netherlands
| | - D J VAN-Veldhuisen
- Department of Cardiology, University of Groningen, University Medical Center Groningen (UMCG), Groningen, the Netherlands
| | - A A Voors
- Department of Cardiology, University of Groningen, University Medical Center Groningen (UMCG), Groningen, the Netherlands
| | - K Damman
- Department of Cardiology, University of Groningen, University Medical Center Groningen (UMCG), Groningen, the Netherlands
| | - B D Westenbrink
- Department of Cardiology, University of Groningen, University Medical Center Groningen (UMCG), Groningen, the Netherlands.
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3
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Tromp J, Beusekamp JC, Ouwerkerk W, Meer P, Cleland JG, Angermann CE, Dahlstrom U, Ertl G, Hassanein M, Perrone SV, Ghadanfar M, Schweizer A, Obergfell A, Filippatos G, Dickstein K, Collins SP, Lam CS. Regional Differences in Precipitating Factors of Hospitalization for Acute Heart Failure: Insights from the
REPORT‐HF
Registry. Eur J Heart Fail 2022; 24:645-652. [PMID: 35064730 PMCID: PMC9106888 DOI: 10.1002/ejhf.2431] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 01/05/2022] [Accepted: 01/14/2022] [Indexed: 11/11/2022] Open
Abstract
AIMS Few prior studies have investigated differences in precipitants leading to hospitalizations for acute heart failure (AHF) in a cohort with global representation. METHODS AND RESULTS We analysed the prevalence of precipitants and their association with outcomes in 18 553 patients hospitalized for AHF in REPORT-HF (prospective international REgistry to assess medical Practice with lOngitudinal obseRvation for Treatment of Heart Failure) according to left ventricular ejection fraction subtype (reduced [HFrEF] and preserved ejection fraction [HFpEF]) and presentation (new-onset vs. decompensated chronic heart failure [DCHF]). Patients were enrolled from 358 centres in 44 countries stratified according to Latin America, North America, Western Europe, Eastern Europe, Eastern Mediterranean and Africa, Southeast Asia, and Western Pacific. Precipitants were pre-with mutually exclusive categories and selected according to the local investigator's discretion. Outcomes included in-hospital and 1-year mortality. The median age was 67 (interquartile range 57-77) years, and 39% were women. Acute coronary syndrome (ACS) was the most common precipitant in patients with new-onset heart failure in all regions except for North America and Western Europe, where uncontrolled hypertension and arrhythmia, respectively, were the most common precipitants, independent of confounders. In patients with DCHF, non-adherence to diet/medication was the most common precipitant regardless of region. Uncontrolled hypertension was a more likely precipitant in HFpEF, non-adherence to diet/medication, and ACS were more likely precipitants in HFrEF. Patients admitted due to worsening renal function had the worst in-hospital (5%) and 1-year post-discharge (30%) mortality rates, regardless of region, heart failure subtype and admission type (pinteraction >0.05 for all). CONCLUSION Data on global differences in precipitants for AHF highlight potential regional differences in targets for preventing hospitalization for AHF and identifying those at highest risk for early mortality.
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Affiliation(s)
- Jasper Tromp
- Saw Swee Hock School of Public Health National University of Singapore and National University Health System Singapore
- Duke‐NUS Medical School Singapore
| | - Joost C. Beusekamp
- University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - Wouter Ouwerkerk
- National Heart Centre Singapore Singapore
- Dept of Dermatology Amsterdam UMC, University of Amsterdam, Amsterdam Infection & Immunity Institute Amsterdam The Netherlands
| | - Peter Meer
- University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - John G.F. Cleland
- Robertson Centre for Biostatistics and Clinical Trials, Institute of Health & Well‐Being, University of Glasgow and National Heart & Lung Institute, Imperial College London
| | - Christiane E. Angermann
- Comprehensive Heart Failure Centre, University Hospital and University of Würzburg Würzburg Germany
| | - Ulf Dahlstrom
- Department of Cardiology and Department of Health, Medicine and Caring Sciences Linkoping University Linkoping Sweden
| | - Georg Ertl
- Comprehensive Heart Failure Centre, University Hospital and University of Würzburg Würzburg Germany
| | - Mahmoud Hassanein
- Alexandria University, Faculty of Medicine, Cardiology Department Alexandria Egypt
| | - Sergio V. Perrone
- El Cruce Hospital by Florencio Varela, Lezica Cardiovascular Institute, Sanctuary of the Trinidad Miter Buenos Aires Argentina
| | | | | | | | - Gerasimos Filippatos
- University of Cyprus, School of Medicine & National and Kapodistrian University of Athens, School of Medicine, Department of Cardiology Attikon University Hospital Athens Greece
| | | | - Sean P Collins
- Vanderbilt University Medical Center, Department of Emergency Medicine Nashville TN USA
| | - Carolyn S.P. Lam
- Duke‐NUS Medical School Singapore
- University of Groningen, University Medical Center Groningen Groningen The Netherlands
- National Heart Centre Singapore Singapore
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4
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Beusekamp JC, Tromp J, Boorsma EM, Heerspink HJL, Damman K, Voors AA, van der Meer P. Effects of sodium-glucose co-transporter 2 inhibition with empagliflozin on potassium handling in patients with acute heart failure. Eur J Heart Fail 2021; 23:1049-1052. [PMID: 33899306 PMCID: PMC8360090 DOI: 10.1002/ejhf.2197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/25/2021] [Accepted: 04/21/2021] [Indexed: 12/26/2022] Open
Affiliation(s)
- Joost C Beusekamp
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jasper Tromp
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,National Heart Centre Singapore & Duke-National University of Singapore, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Eva M Boorsma
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Hiddo J L Heerspink
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,George Institute for Global Health, Sydney, Australia
| | - Kevin Damman
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Adriaan A Voors
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Peter van der Meer
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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5
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Boorsma EM, Beusekamp JC, ter Maaten JM, Figarska SM, Danser AJ, van Veldhuisen DJ, van der Meer P, Heerspink HJ, Damman K, Voors AA. Effects of empagliflozin on renal sodium and glucose handling in patients with acute heart failure. Eur J Heart Fail 2020; 23:68-78. [PMID: 33251643 PMCID: PMC8048437 DOI: 10.1002/ejhf.2066] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 11/01/2020] [Accepted: 11/23/2020] [Indexed: 12/18/2022] Open
Abstract
AIMS Sodium-glucose co-transporter 2 (SGLT2) inhibitors improve clinical outcome in patients with heart failure (HF), but the mechanisms behind their beneficial effects are not yet fully understood. We examined the effects of empagliflozin on renal sodium and glucose handling in patients with acute HF. METHODS AND RESULTS This study was a pre-defined sub-study of a double-blind, randomized, placebo-controlled, multicentre study (EMPA-RESPONSE-AHF). Patients were allocated within 24 h of an acute HF admission to either empagliflozin 10 mg/day (n = 40) or placebo (n = 39) for 30 days. Markers of glucose and sodium handling were measured daily during the first 96 h and at day 30. Patients were 76 (range 38-89) years old and 33% had diabetes. The use of loop diuretics during the first 96 h was similar in both groups. Empagliflozin increased fractional glucose excretion with a peak after 24 h (21.8% vs. 0.1%; P < 0.001), without affecting plasma glucose concentration, while fractional sodium and chloride excretion and urinary osmolality remained unchanged (P >0.3 for all). However, empagliflozin increased plasma osmolality (delta osmolality at 72 h: 5 ± 8 vs. 2 ± 5 mOsm/kg; P = 0.049). Finally, there was an early decline in estimated glomerular filtration rate with empagliflozin vs. placebo (-10 ± 12 vs. -2 ± 12 mL/min/1.73 m2 ; P = 0.009), which recovered within 30 days. CONCLUSION In patients with acute HF, empagliflozin increased fractional glucose excretion and plasma osmolality, without affecting fractional sodium excretion or urine osmolality and caused a temporary decline in estimated glomerular filtration rate. This suggests that empagliflozin stimulates osmotic diuresis through increased glycosuria rather than natriuresis in patients with acute HF.
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Affiliation(s)
- Eva M. Boorsma
- University of Groningen, University Medical Center GroningenGroningenThe Netherlands
| | - Joost C. Beusekamp
- University of Groningen, University Medical Center GroningenGroningenThe Netherlands
| | - Jozine M. ter Maaten
- University of Groningen, University Medical Center GroningenGroningenThe Netherlands
| | - Sylwia M. Figarska
- University of Groningen, University Medical Center GroningenGroningenThe Netherlands
| | - A.H. Jan Danser
- Department of Internal Medicine, Division of PharmacologyErasmus University Medical Center RotterdamRotterdamThe Netherlands
| | | | - Peter van der Meer
- University of Groningen, University Medical Center GroningenGroningenThe Netherlands
| | - Hiddo J.L. Heerspink
- University of Groningen, University Medical Center GroningenGroningenThe Netherlands
| | - Kevin Damman
- University of Groningen, University Medical Center GroningenGroningenThe Netherlands
| | - Adriaan A. Voors
- University of Groningen, University Medical Center GroningenGroningenThe Netherlands
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6
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Damman K, Beusekamp JC, Boorsma EM, Swart HP, Smilde TDJ, Elvan A, van Eck JWM, Heerspink HJL, Voors AA. Randomized, double-blind, placebo-controlled, multicentre pilot study on the effects of empagliflozin on clinical outcomes in patients with acute decompensated heart failure (EMPA-RESPONSE-AHF). Eur J Heart Fail 2020; 22:713-722. [PMID: 31912605 DOI: 10.1002/ejhf.1713] [Citation(s) in RCA: 232] [Impact Index Per Article: 58.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 11/19/2019] [Accepted: 11/22/2019] [Indexed: 12/14/2022] Open
Abstract
AIMS Inhibition of sodium-glucose co-transporter 2 (SGLT2) reduces the risk of death and heart failure (HF) admissions in patients with chronic HF. However, safety and clinical efficacy of SGLT2 inhibitors in patients with acute decompensated HF are unknown. METHODS AND RESULTS In this randomized, placebo-controlled, double-blind, parallel group, multicentre pilot study, we randomized 80 acute HF patients with and without diabetes to either empagliflozin 10 mg/day or placebo for 30 days. The primary outcomes were change in visual analogue scale (VAS) dyspnoea score, diuretic response (weight change per 40 mg furosemide), change in N-terminal pro brain natriuretic peptide (NT-proBNP), and length of stay. Secondary outcomes included safety and clinical endpoints. Mean age was 76 years, 33% were female, 47% had de novo HF and median NT-proBNP was 5236 pg/mL. No difference was observed in VAS dyspnoea score, diuretic response, length of stay, or change in NT-proBNP between empagliflozin and placebo. Empagliflozin reduced a combined endpoint of in-hospital worsening HF, rehospitalization for HF or death at 60 days compared with placebo [4 (10%) vs. 13 (33%); P = 0.014]. Urinary output up until day 4 was significantly greater with empagliflozin vs. placebo [difference 3449 (95% confidence interval 578-6321) mL; P < 0.01]. Empagliflozin was safe, well tolerated, and had no adverse effects on blood pressure or renal function. CONCLUSIONS In patients with acute HF, treatment with empagliflozin had no effect on change in VAS dyspnoea, diuretic response, NT-proBNP, and length of hospital stay, but was safe, increased urinary output and reduced a combined endpoint of worsening HF, rehospitalization for HF or death at 60 days.
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Affiliation(s)
- Kevin Damman
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Joost C Beusekamp
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Eva M Boorsma
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Henk P Swart
- Antonius Ziekenhuis Sneek, Sneek, The Netherlands
| | | | - Arif Elvan
- Department of Cardiology, ISALA, Zwolle, The Netherlands
| | | | - Hiddo J L Heerspink
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,The George Institute for Global Health, Sydney, Australia
| | - Adriaan A Voors
- University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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7
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Beusekamp JC, Teng THK, Tay WT, Ouwerkerk W, Richards AM, Anand IS, Chopra VK, Wander GS, van der Meer P, Voors AA, Lam CSP, Tromp J. Potassium abnormalities in patients with heart failure from 11 Asian regions: insights from the ASIAN-HF registry. Eur J Heart Fail 2019; 22:751-754. [PMID: 31851416 DOI: 10.1002/ejhf.1640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 09/09/2019] [Accepted: 09/16/2019] [Indexed: 12/28/2022] Open
Affiliation(s)
- Joost C Beusekamp
- Department of Cardiology, University of Groningen, Groningen, The Netherlands
| | - Tiew-Hwa Katherine Teng
- National Heart Centre Singapore, Singapore, Singapore.,School of Population Health, University of Western Australia, Crawley, Australia
| | - Wan Ting Tay
- National Heart Centre Singapore, Singapore, Singapore
| | - Wouter Ouwerkerk
- National Heart Centre Singapore, Singapore, Singapore.,Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, Amsterdam, The Netherlands
| | - A Mark Richards
- Cardiovascular Research Institute, National University Heart Centre, Singapore, Singapore
| | - Inder S Anand
- University of Minnesota Medical School, Minneapolis, MN, USA
| | | | | | - Peter van der Meer
- Department of Cardiology, University of Groningen, Groningen, The Netherlands
| | - Adriaan A Voors
- Department of Cardiology, University of Groningen, Groningen, The Netherlands
| | - Carolyn S P Lam
- Department of Cardiology, University of Groningen, Groningen, The Netherlands.,National Heart Centre Singapore, Singapore, Singapore.,Cardiovascular Research Institute, National University Heart Centre, Singapore, Singapore.,Duke-National University of Singapore Medical School, Singapore, Singapore.,George institute for global health, Sydney, Australia
| | - Jasper Tromp
- Department of Cardiology, University of Groningen, Groningen, The Netherlands.,National Heart Centre Singapore, Singapore, Singapore.,Duke-National University of Singapore Medical School, Singapore, Singapore
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8
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Beusekamp JC, Tromp J, Cleland JG, Givertz MM, Metra M, O’Connor CM, Teerlink JR, Ponikowski P, Ouwerkerk W, van Veldhuisen DJ, Voors AA, van der Meer P. Hyperkalemia and Treatment With RAAS Inhibitors During Acute Heart Failure Hospitalizations and Their Association With Mortality. JACC: Heart Failure 2019; 7:970-979. [DOI: 10.1016/j.jchf.2019.07.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 07/11/2019] [Accepted: 07/15/2019] [Indexed: 12/28/2022]
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9
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Beusekamp JC, Tromp J, Cleland JGF, Givertz MM, Metra M, O'Connor CM, Teerlink JR, Ponikowski P, Ouwerkerk W, van Veldhuisen DJ, Voors AA, van der Meer P. Hyperkalemia and Treatment With RAAS Inhibitors During Acute Heart Failure Hospitalizations and Their Association With Mortality. JACC Heart Fail 2019. [PMID: 31606364 DOI: 10.1016/j.jchf.2019.07.010"] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
OBJECTIVES This study investigated associations between incident hyperkalemia during acute heart failure (HF) hospitalizations and changes in renin-angiotensin-aldosterone system (RAAS) inhibitors. BACKGROUND Hyperkalemia is a potential complication of RAAS inhibitors. For patients with HF, fear of hyperkalemia may lead to failure to deliver guideline-recommended doses of RAAS inhibitors. METHODS Serum potassium concentrations were measured daily from baseline (<24 h after admission) until discharge or day 7 in 1,589 patients enrolled in the PROTECT (Placebo-Controlled Randomized Study of the Selective A1 Adenosine Receptor Antagonist Rolofylline for Patients Hospitalized with Acute Decompensated Heart Failure and Volume Overload to Assess Treatment Effect on Congestion and Renal Function) trial. Incident hyperkalemia was defined as at least 1 episode of potassium >5.0 mEq/l. The primary outcome was all-cause mortality at 180 days. RESULTS Overall, serum potassium concentrations increased from 4.3 ± 0.6 mEq/l at baseline to 4.5 ± 0.6 mEq/l at discharge or day 7 (p < 0.001). Patients developing incident hyperkalemia (n = 564; 35%) were more often taking mineralocorticoid antagonists (MRAs) therapy prior to hospitalization and were more likely to have them down-titrated during hospitalization, independent of confounders. Incident hyperkalemia was not associated with adverse outcomes. Yet, down-titration of MRAs during hospitalization was independently associated with 180-day mortality (hazard ratio [HR]: 1.73; 95% confidence interval [CI]: 1.15 to 2.60), regardless of incident hyperkalemia (pinteraction >0.10). Patients with incident hyperkalemia who were discharged with the same or increased dose of MRAs (HR: 0.52; 95% CI: 0.32 to 0.85) or angiotensin-converting enzyme (ACE) inhibitors/angiotensin receptor blockers (ARBs) (HR: 0.47; 95% CI: 0.29 to 0.77) had a lower 180-day mortality. CONCLUSIONS Incident hyperkalemia is common in patients hospitalized for acute HF and is not associated with adverse outcomes. Incident hyperkalemia is associated with down-titration of MRAs, but patients who maintained or increased their dose of MRAs and/or ACE inhibitors/ARB during acute HF hospitalization had better 180-day survival.
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Affiliation(s)
- Joost C Beusekamp
- Department of Cardiology, University of Groningen, Groningen, the Netherlands
| | - Jasper Tromp
- Department of Cardiology, University of Groningen, Groningen, the Netherlands; Department of Cardiology, National Heart Centre Singapore, Singapore; Duke-National University of Singapore Medical School, Singapore
| | - John G F Cleland
- Department of Cardiology, University of Hull, Hull, United Kingdom
| | - Michael M Givertz
- Department of Medicine, Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
| | - Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | | | - John R Teerlink
- University of California at San Francisco and San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Piotr Ponikowski
- Department of Cardiology, Medical University, Clinical Military Hospital, Wroclaw, Poland
| | - Wouter Ouwerkerk
- Department of Cardiology, National Heart Centre Singapore, Singapore; Department of Dermatology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam Infection and Immunity Institute, Amsterdam, the Netherlands
| | | | - Adriaan A Voors
- Department of Cardiology, University of Groningen, Groningen, the Netherlands
| | - Peter van der Meer
- Department of Cardiology, University of Groningen, Groningen, the Netherlands.
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10
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Beusekamp JC, Tromp J, van der Wal HH, Anker SD, Cleland JG, Dickstein K, Filippatos G, van der Harst P, Hillege HL, Lang CC, Metra M, Ng LL, Ponikowski P, Samani NJ, van Veldhuisen DJ, Zwinderman AH, Rossignol P, Zannad F, Voors AA, van der Meer P. Potassium and the use of renin-angiotensin-aldosterone system inhibitors in heart failure with reduced ejection fraction: data from BIOSTAT-CHF. Eur J Heart Fail 2018; 20:923-930. [PMID: 29327797 DOI: 10.1002/ejhf.1079] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 10/10/2017] [Accepted: 10/15/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Hyperkalaemia is a common co-morbidity in patients with heart failure with reduced ejection fraction (HFrEF). Whether it affects the use of renin-angiotensin-aldosterone system inhibitors and thereby negatively impacts outcome is unknown. Therefore, we investigated the association between potassium and uptitration of angiotensin-converting enzyme inhibitors (ACEi)/angiotensin receptor blockers (ARB) and its association with outcome. METHODS AND RESULTS Out of 2516 patients from the BIOSTAT-CHF study, potassium levels were available in 1666 patients with HFrEF. These patients were sub-optimally treated with ACEi/ARB or beta-blockers and were anticipated and encouraged to be uptitrated. Potassium levels were available at inclusion and at 9 months. Outcome was a composite of all-cause mortality and heart failure hospitalization at 2 years. Patients' mean age was 67 ± 12 years and 77% were male. At baseline, median serum potassium was 4.3 (interquartile range 3.9-4.6) mEq/L. After 9 months, 401 (24.1%) patients were successfully uptitrated with ACEi/ARB. During this period, mean serum potassium increased by 0.16 ± 0.66 mEq/L (P < 0.001). Baseline potassium was an independent predictor of lower ACEi/ARB dosage achieved [odds ratio 0.70; 95% confidence interval (CI) 0.51-0.98]. An increase in potassium was not associated with adverse outcomes (hazard ratio 1.15; 95% CI 0.86-1.53). No interaction on outcome was found between baseline potassium, potassium increase during uptitration, or potassium at 9 months and increased dosage of ACEi/ARB (Pinteraction > 0.5 for all). CONCLUSION Higher potassium levels are an independent predictor of enduring lower dosages of ACEi/ARB. Higher potassium levels do not attenuate the beneficial effects of ACEi/ARB uptitration.
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Affiliation(s)
- Joost C Beusekamp
- Department of Cardiology, University of Groningen, Groningen, The Netherlands
| | - Jasper Tromp
- Department of Cardiology, University of Groningen, Groningen, The Netherlands
- National Heart Centre Singapore, Singapore
| | - Haye H van der Wal
- Department of Cardiology, University of Groningen, Groningen, The Netherlands
| | - Stefan D Anker
- Innovative Clinical Trials, Department of Cardiology and Pneumology, University Medical Center Göttingen (UMG), Göttingen, Germany
- Division of Cardiology and Metabolism-Heart Failure, Cachexia and Sarcopenia, Department of Cardiology, and Berlin-Brandenburg Center for Regenerative Therapies, Charité University Medicine, Berlin, Germany
| | - John G Cleland
- National Heart and Lung Institute, Royal Brompton and Harefield Hospitals, Imperial College, London, UK
| | - Kenneth Dickstein
- University of Bergen, Bergen, Norway
- Stavanger University Hospital, Stavanger, Norway
| | - Gerasimos Filippatos
- National and Kapodistrian University of Athens, School of Medicine and Department of Cardiology, Heart Failure Unit, Athens University Hospital Attikon, Athens, Greece
| | - Pim van der Harst
- Department of Cardiology, University of Groningen, Groningen, The Netherlands
| | - Hans L Hillege
- Department of Cardiology, University of Groningen, Groningen, The Netherlands
| | - Chim C Lang
- School of Medicine Centre for Cardiovascular and Lung Biology, Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK
| | - Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Leong L Ng
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, Leicester, UK, and NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Piotr Ponikowski
- Department of Heart Diseases, Wroclaw Medical University, Poland, and Cardiology Department, Military Hospital, Wroclaw, Poland
| | - Nilesh J Samani
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, Leicester, UK, and NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | | | - Aeilko H Zwinderman
- Department of Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, Amsterdam, The Netherlands
| | - Patrick Rossignol
- Inserm CIC-P 1433, Université de Lorraine, CHRU de Nancy, FCRIN INI-CRCT, Nancy, France
| | - Faiez Zannad
- Inserm CIC-P 1433, Université de Lorraine, CHRU de Nancy, FCRIN INI-CRCT, Nancy, France
| | - Adriaan A Voors
- Department of Cardiology, University of Groningen, Groningen, The Netherlands
| | - Peter van der Meer
- Department of Cardiology, University of Groningen, Groningen, The Netherlands
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