Association Between Serum Potassium Levels and Short-Term Mortality in Patients With Atrial Fibrillation or Flutter Co-treated With Diuretics and Rate- or Rhythm-Controlling Drugs

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Resumé

AIM: We investigated the association between potassium levels and 90-day all-cause mortality in atrial fibrillation or flutter (AF) patients co-treated with diuretics and rate- or rhythm-controlling drugs.

METHODS AND RESULTS: During 2000-2012, first-time AF patients treated with beta-blockers, amiodarone, sotalol, verapamil, and/or digoxin combined with any diuretic within 90 days post-AF discharge were included. Following co-treatment, a potassium measurement within 90 days after initiating diuretic treatment was required. Mortality risk associated with potassium <3.5, 3.5-3.7, 3.8-4.0, 4.5-4.7, 4.8-5.0, and >5.0 mmol/L (reference: 4.1-4.4 mmol/L) was assessed using Multivariable Cox regression. In total, 14,425 AF patients were included (median age: 78 years; women: 52%). Patients most often received beta-blocker monotherapy (29%), beta-blocker and digoxin combined (25%), digoxin monotherapy (24%), amiodarone monotherapy (3%), and verapamil monotherapy (3%). Increased 90-day mortality risk was associated with <3.5 mmol/L (HR 2.05, 95% CI: 1.68-2.50), 3.5-3.7 mmol/L (HR: 1.28, 95% CI 1.05-1.57), 4.5-4.7 mmol/L (HR: 1.20, 95% CI: 1.02-1.41), 4.8-5.0 mmol/L, (HR: 1.37, 95% CI: 1.14-1.66) and >5.0 mmol/L: (HR: 1.84, 95% CI: 1.53-2.21). Compared with beta-blocker monotherapy, rate- or rhythm-controlling drugs did not modify the association between potassium groups and mortality risk.

CONCLUSION: In addition to hypo- and hyperkalemia, low and high normal range potassium levels were associated with increased 90-day mortality risk in AF patients co-treated with diuretics and rate- or rhythm-controlling drugs. These associations were independent of rate- or rhythm-controlling drugs.

OriginalsprogEngelsk
TidsskriftEuropean heart journal. Cardiovascular pharmacotherapy
ISSN2055-6837
DOI
StatusE-pub ahead of print - 2 jul. 2019

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Atrial Flutter
Diuretics
Atrial Fibrillation
Potassium
Digoxin
Mortality
Serum
Pharmaceutical Preparations
Amiodarone
Verapamil
Sotalol
Hyperkalemia
Hypokalemia
Reference Values
Therapeutics

Citer dette

@article{83de917e373646b496f15bee4308d5c7,
title = "Association Between Serum Potassium Levels and Short-Term Mortality in Patients With Atrial Fibrillation or Flutter Co-treated With Diuretics and Rate- or Rhythm-Controlling Drugs",
abstract = "AIM: We investigated the association between potassium levels and 90-day all-cause mortality in atrial fibrillation or flutter (AF) patients co-treated with diuretics and rate- or rhythm-controlling drugs.METHODS AND RESULTS: During 2000-2012, first-time AF patients treated with beta-blockers, amiodarone, sotalol, verapamil, and/or digoxin combined with any diuretic within 90 days post-AF discharge were included. Following co-treatment, a potassium measurement within 90 days after initiating diuretic treatment was required. Mortality risk associated with potassium <3.5, 3.5-3.7, 3.8-4.0, 4.5-4.7, 4.8-5.0, and >5.0 mmol/L (reference: 4.1-4.4 mmol/L) was assessed using Multivariable Cox regression. In total, 14,425 AF patients were included (median age: 78 years; women: 52{\%}). Patients most often received beta-blocker monotherapy (29{\%}), beta-blocker and digoxin combined (25{\%}), digoxin monotherapy (24{\%}), amiodarone monotherapy (3{\%}), and verapamil monotherapy (3{\%}). Increased 90-day mortality risk was associated with <3.5 mmol/L (HR 2.05, 95{\%} CI: 1.68-2.50), 3.5-3.7 mmol/L (HR: 1.28, 95{\%} CI 1.05-1.57), 4.5-4.7 mmol/L (HR: 1.20, 95{\%} CI: 1.02-1.41), 4.8-5.0 mmol/L, (HR: 1.37, 95{\%} CI: 1.14-1.66) and >5.0 mmol/L: (HR: 1.84, 95{\%} CI: 1.53-2.21). Compared with beta-blocker monotherapy, rate- or rhythm-controlling drugs did not modify the association between potassium groups and mortality risk.CONCLUSION: In addition to hypo- and hyperkalemia, low and high normal range potassium levels were associated with increased 90-day mortality risk in AF patients co-treated with diuretics and rate- or rhythm-controlling drugs. These associations were independent of rate- or rhythm-controlling drugs.",
author = "Louise Hagengaard and Peter S{\o}gaard and Marie Espersen and Maurizio Sessa and Lund, {Peter Enemark} and Krogager, {Maria Lukacs} and Christian Torp-Pedersen and Kragholm, {Kristian Hay} and Christoffer Polcwiartek",
year = "2019",
month = "7",
day = "2",
doi = "10.1093/ehjcvp/pvz024",
language = "English",
journal = "European Heart Journal - Cardiovascular Pharmacotherapy",
issn = "2055-6837",
publisher = "Oxford University Press",

}

TY - JOUR

T1 - Association Between Serum Potassium Levels and Short-Term Mortality in Patients With Atrial Fibrillation or Flutter Co-treated With Diuretics and Rate- or Rhythm-Controlling Drugs

AU - Hagengaard, Louise

AU - Søgaard, Peter

AU - Espersen, Marie

AU - Sessa, Maurizio

AU - Lund, Peter Enemark

AU - Krogager, Maria Lukacs

AU - Torp-Pedersen, Christian

AU - Kragholm, Kristian Hay

AU - Polcwiartek, Christoffer

PY - 2019/7/2

Y1 - 2019/7/2

N2 - AIM: We investigated the association between potassium levels and 90-day all-cause mortality in atrial fibrillation or flutter (AF) patients co-treated with diuretics and rate- or rhythm-controlling drugs.METHODS AND RESULTS: During 2000-2012, first-time AF patients treated with beta-blockers, amiodarone, sotalol, verapamil, and/or digoxin combined with any diuretic within 90 days post-AF discharge were included. Following co-treatment, a potassium measurement within 90 days after initiating diuretic treatment was required. Mortality risk associated with potassium <3.5, 3.5-3.7, 3.8-4.0, 4.5-4.7, 4.8-5.0, and >5.0 mmol/L (reference: 4.1-4.4 mmol/L) was assessed using Multivariable Cox regression. In total, 14,425 AF patients were included (median age: 78 years; women: 52%). Patients most often received beta-blocker monotherapy (29%), beta-blocker and digoxin combined (25%), digoxin monotherapy (24%), amiodarone monotherapy (3%), and verapamil monotherapy (3%). Increased 90-day mortality risk was associated with <3.5 mmol/L (HR 2.05, 95% CI: 1.68-2.50), 3.5-3.7 mmol/L (HR: 1.28, 95% CI 1.05-1.57), 4.5-4.7 mmol/L (HR: 1.20, 95% CI: 1.02-1.41), 4.8-5.0 mmol/L, (HR: 1.37, 95% CI: 1.14-1.66) and >5.0 mmol/L: (HR: 1.84, 95% CI: 1.53-2.21). Compared with beta-blocker monotherapy, rate- or rhythm-controlling drugs did not modify the association between potassium groups and mortality risk.CONCLUSION: In addition to hypo- and hyperkalemia, low and high normal range potassium levels were associated with increased 90-day mortality risk in AF patients co-treated with diuretics and rate- or rhythm-controlling drugs. These associations were independent of rate- or rhythm-controlling drugs.

AB - AIM: We investigated the association between potassium levels and 90-day all-cause mortality in atrial fibrillation or flutter (AF) patients co-treated with diuretics and rate- or rhythm-controlling drugs.METHODS AND RESULTS: During 2000-2012, first-time AF patients treated with beta-blockers, amiodarone, sotalol, verapamil, and/or digoxin combined with any diuretic within 90 days post-AF discharge were included. Following co-treatment, a potassium measurement within 90 days after initiating diuretic treatment was required. Mortality risk associated with potassium <3.5, 3.5-3.7, 3.8-4.0, 4.5-4.7, 4.8-5.0, and >5.0 mmol/L (reference: 4.1-4.4 mmol/L) was assessed using Multivariable Cox regression. In total, 14,425 AF patients were included (median age: 78 years; women: 52%). Patients most often received beta-blocker monotherapy (29%), beta-blocker and digoxin combined (25%), digoxin monotherapy (24%), amiodarone monotherapy (3%), and verapamil monotherapy (3%). Increased 90-day mortality risk was associated with <3.5 mmol/L (HR 2.05, 95% CI: 1.68-2.50), 3.5-3.7 mmol/L (HR: 1.28, 95% CI 1.05-1.57), 4.5-4.7 mmol/L (HR: 1.20, 95% CI: 1.02-1.41), 4.8-5.0 mmol/L, (HR: 1.37, 95% CI: 1.14-1.66) and >5.0 mmol/L: (HR: 1.84, 95% CI: 1.53-2.21). Compared with beta-blocker monotherapy, rate- or rhythm-controlling drugs did not modify the association between potassium groups and mortality risk.CONCLUSION: In addition to hypo- and hyperkalemia, low and high normal range potassium levels were associated with increased 90-day mortality risk in AF patients co-treated with diuretics and rate- or rhythm-controlling drugs. These associations were independent of rate- or rhythm-controlling drugs.

U2 - 10.1093/ehjcvp/pvz024

DO - 10.1093/ehjcvp/pvz024

M3 - Journal article

JO - European Heart Journal - Cardiovascular Pharmacotherapy

JF - European Heart Journal - Cardiovascular Pharmacotherapy

SN - 2055-6837

ER -