TY - JOUR
T1 - Effects of hyperkalaemia and non-adherence to renin–angiotensin–aldosterone system inhibitor therapy in patients with heart failure in Italy
T2 - a propensity-matched study
AU - Volterrani, Maurizio
AU - Perrone, Valentina
AU - Sangiorgi, Diego
AU - Giacomini, Elisa
AU - Iellamo, Ferdinando
AU - Degli Esposti, Luca
AU - on the behalf of a LHUs Study Group (see Appendix)
N1 - Funding Information:
Vifor Pharma Italia purchased the study report that is the basis for this manuscript. This manuscript was developed with Vifor Pharma Italia and CliCon S.r.l. The views expressed here are those of the authors and not necessarily those of the supporters. The agreement signed by Clicon S.r.l. and Vifor Pharma Italia does not create any entityship, joint venture or any similar relationship between parties. Clicon S.r.l. is an independent company. Neither CliCon S.r.l. nor any of their representatives are employees of Vifor Pharma Italia for any purpose. An extract of the manuscript was published in Italian language in G Ital Nefrol 2019;36:2019?vol5 (https://www.ncbi.nlm.nih.gov/pubmed/31580544). Conflict of interest: none declared.
Publisher Copyright:
© 2020 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/11
Y1 - 2020/11
N2 - Aims: The aims of this study were to evaluate if the risk of cardiovascular events and all-cause mortality was higher in the presence of hyperkalaemia (HK) in patients with heart failure (HF) treated with renin–angiotensin–aldosterone system inhibitors (RAASi), and to investigate in this cohort the increased risk of cardiovascular events and all-cause mortality among HK patients with non-optimal adherence to RAASi therapy. Methods and results: In this retrospective cohort study based on administrative databases of five Italian Local Health Units, all adult patients with a HF diagnosis between January 2010 and December 2017 were included only if they were prescribed RAASi therapy during the first 3 months after the index date, that corresponded to the date of first HF diagnosis during the inclusion period. Patients were considered to have HK if serum potassium level was ≥5.5 mmol/L. A propensity score matching was applied before evaluation of hazard ratios. Patients with HK were 37% (P < 0.001) and 70% (P < 0.001), respectively, more at risk of cardiovascular events and of dying for all-cause mortality compared to non-HK patients. Among the HK group, patients non-adherent to RAASi therapy had a 39% (P = 0.105) higher risk of cardiovascular events and a twofold increased risk (P < 0.001) of all-cause death. Conclusion: Findings from this real-world study showed that in a cohort of HF patients under RAASi therapy, subjects with HK had an enhanced risk of cardiovascular events or death compared to patients without HK. Moreover, in HK patients, sub-optimal adherence to RAASi therapy was associated with an increased risk of all-cause mortality.
AB - Aims: The aims of this study were to evaluate if the risk of cardiovascular events and all-cause mortality was higher in the presence of hyperkalaemia (HK) in patients with heart failure (HF) treated with renin–angiotensin–aldosterone system inhibitors (RAASi), and to investigate in this cohort the increased risk of cardiovascular events and all-cause mortality among HK patients with non-optimal adherence to RAASi therapy. Methods and results: In this retrospective cohort study based on administrative databases of five Italian Local Health Units, all adult patients with a HF diagnosis between January 2010 and December 2017 were included only if they were prescribed RAASi therapy during the first 3 months after the index date, that corresponded to the date of first HF diagnosis during the inclusion period. Patients were considered to have HK if serum potassium level was ≥5.5 mmol/L. A propensity score matching was applied before evaluation of hazard ratios. Patients with HK were 37% (P < 0.001) and 70% (P < 0.001), respectively, more at risk of cardiovascular events and of dying for all-cause mortality compared to non-HK patients. Among the HK group, patients non-adherent to RAASi therapy had a 39% (P = 0.105) higher risk of cardiovascular events and a twofold increased risk (P < 0.001) of all-cause death. Conclusion: Findings from this real-world study showed that in a cohort of HF patients under RAASi therapy, subjects with HK had an enhanced risk of cardiovascular events or death compared to patients without HK. Moreover, in HK patients, sub-optimal adherence to RAASi therapy was associated with an increased risk of all-cause mortality.
KW - Adherence
KW - Heart failure
KW - Hyperkalaemia
KW - Real world
KW - Renin–angiotensin–aldosterone system inhibitors
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U2 - 10.1002/ejhf.2024
DO - 10.1002/ejhf.2024
M3 - Article
C2 - 33459467
AN - SCOPUS:85096839234
VL - 22
SP - 2049
EP - 2055
JO - European Journal of Heart Failure
JF - European Journal of Heart Failure
SN - 1388-9842
IS - 11
ER -