西班牙心力衰竭患者的高钾血症及其对指南和建议的影响：欧洲心脏病学会-欧洲心脏病学注册研究-心力衰竭协会心力衰竭长期注册研究
Hyperkalemia in heart failure patients in Spain and its impact on guidelines and recommendations: ESC-EORP-HFA Heart Failure Long-Term Registry.
作者信息
Crespo-Leiro María G, Barge-Caballero Eduardo, Segovia-Cubero Javier, González-Costello José, López-Fernández Silvia, García-Pinilla José Manuel, Almenar-Bonet Luis, de Juan-Bagudá Javier, Roig-Minguell Eulalia, Bayés-Genís Antoni, Sanz-Julve Marisa, Lambert-Rodríguez José Luis, Lara-Padrón Antonio, Pérez-Ruiz José María, Fernández-Vivancos Marquina Carla, de la Fuente-Galán Luis, Varela-Román Alfonso, Torres-Calvo Francisco, Andrés-Novales Javier, Escudero-González Aida, Pascual-Figal Domingo A, Ridocci-Soriano Francisco, Sahuquillo-Martínez Ana, Bierge-Valero David, Epelde-Gonzalo Francisco, Gallego-Page Juan Carlos, Dalmau González-Gallarza Regina, Bover-Freire Ramón, Quiles-Granado Juan, Maggioni Aldo Pietro, Lund Lars H, Muñiz Javier, Delgado-Jiménez Juan
机构信息
Unidad de Insuficiencia Cardiaca y Trasplante, Servicio de Cardiología, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidade da Coruña (UDC), A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain.
Unidad de Insuficiencia Cardiaca y Trasplante, Servicio de Cardiología, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidade da Coruña (UDC), A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain.
出版信息
Rev Esp Cardiol (Engl Ed). 2020 Apr;73(4):313-323. doi: 10.1016/j.rec.2019.05.015. Epub 2019 Oct 28.
INTRODUCTION AND OBJECTIVES
Hyperkalemia is a growing concern in the treatment of patients with heart failure and reduced ejection fraction because it limits the use of effective drugs. We report estimates of the magnitude of this problem in routine clinical practice in Spain, as well as changes in potassium levels during follow-up and associated factors.
METHODS
This study included patients with acute (n=881) or chronic (n=3587) heart failure recruited in 28 Spanish hospitals of the European heart failure registry of the European Society of Cardiology and followed up for 1 year. Various outcomes were analyzed, including changes in serum potassium levels and their impact on treatment.
RESULTS
Hyperkalemia (K> 5.4 mEq/L) was identified in 4.3% (95%CI, 3.7%-5.0%) and 8.2% (6.5%-10.2%) of patients with chronic and acute heart failure, respectively, and was responsible for 28.9% of all cases of contraindication to mineralocorticoid receptor antagonist use and for 10.8% of all cases of failure to reach the target dose. Serum potassium levels were not recorded in 291 (10.8%) of the 2693 chronic heart failure patients with reduced ejection fraction. During follow-up, potassium levels increased in 179 of 1431 patients (12.5%, 95%CI, 10.8%-14.3%). This increase was directly related to age, diabetes, and history of stroke and was inversely related to history of hyperkalemia.
CONCLUSIONS
This study highlights the magnitude of the problem of hyperkalemia in patients with heart failure in everyday clinical practice and the need to improve monitoring of this factor in these patients due to its interference with the possibility of receiving optimal treatment.
引言与目的
高钾血症在射血分数降低的心力衰竭患者治疗中日益受到关注，因为它限制了有效药物的使用。我们报告了西班牙常规临床实践中这一问题的严重程度估计，以及随访期间血钾水平的变化及相关因素。
方法
本研究纳入了在欧洲心脏病学会欧洲心力衰竭注册研究的28家西班牙医院招募的急性（n = 881）或慢性（n = 3587）心力衰竭患者，并随访1年。分析了各种结局，包括血清钾水平的变化及其对治疗的影响。
结果
慢性和急性心力衰竭患者中，高钾血症（K>5.4 mEq/L）的发生率分别为4.3%（95%CI，3.7%-5.0%）和8.2%（6.5%-10.2%），分别占醛固酮受体拮抗剂使用禁忌证所有病例的28.9%和未达到目标剂量所有病例的10.8%。在2693例射血分数降低的慢性心力衰竭患者中，有291例（10.8%）未记录血清钾水平。在随访期间，1431例患者中有179例（12.5%，95%CI，10.8%-14.3%）血钾水平升高。这种升高与年龄、糖尿病和中风病史直接相关，与高钾血症病史呈负相关。
结论
本研究强调了日常临床实践中心力衰竭患者高钾血症问题的严重程度，以及由于其干扰接受最佳治疗的可能性，需要改善对这些患者这一因素的监测。
Zotero 插件