Abstract 4113864: Hyperkalemia In Patients With Heart Failure Correlates to Worse Inpatient Outcomes

Background: Heart failure (HF) is one of the leading causes of hospitalizations in the States. Hyperkalemia is not an infrequent comorbidity in patients with HF, limiting the maximum benefits of guideline-directed medical therapy. This study evaluates the outcomes in patients admitted for HF with and without hyperkalemia. Methods: We used the Nationwide Readmissions Database (NRD) from 2016-2019, extracting adult patients with a primary diagnosis of HF who were admitted between January and November of each year. Survey procedures were applied using SAS 9.4. Results: We included 4,454,273 weighted hospitalizations due to HF for which 380,446 patients (8.5%) had a concurrent diagnosis of hyperkalemia. Overall, patients with hyperkalemia, compared to HF cases with hyperkalemia, were slightly younger (mean age 70 years vs. 72 years, p <0.01) with fewer women (47% vs.48%) respectively. Patients with hyperkalemia had a higher frequency of diabetes mellitus, hypertension, chronic liver disease, acute kidney injury, chronic kidney disease, end-stage renal disease, and acute encephalopathy (p<0.001). They had more inpatient complications including ventricular fibrillation and cardiac arrest (p <0.001) with longer mean lengths of stay (7 days vs. 5 days, p <0.001) and 30-day readmissions (28% vs. 22%, p<0.001). In-hospital mortality during index admission was significantly higher in the hyperkalemic group (6.4% vs. 2.5%, p < 0.001). Inpatient outcomes including mortality were also worse during first readmission (7% vs. 6%, p<0.01). Even after adjustment for the above-mentioned comorbidities, multivariable analysis reveals that hyperkalemia is an independent factor for inpatient mortality (adjusted OR 1.9 [1.8-2], p<0.001). Conclusion: Hyperkalemia in patients admitted with HF is associated with increased inpatient mortality and readmission. Further studies can investigate whether novel potassium binders may improve outcomes.