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

Eur Heart J Cardiovasc Pharmacother. 2020 Jul 1;6(3):137-144. doi: 10.1093/ehjcvp/pvz024.

Abstract

Aims: 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 2000-12, first-time AF patients treated with beta-blockers, amiodarone, sotalol, verapamil, 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-blockers 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 [hazard ratio (HR) 2.05, 95% confidence interval (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 hyperkalaemia, 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.

Keywords: Atrial fibrillation; Diuretics; Mortality; Potassium; Rate- or rhythm-controlling drugs.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Anti-Arrhythmia Agents / adverse effects
  • Anti-Arrhythmia Agents / therapeutic use*
  • Atrial Fibrillation / diagnosis
  • Atrial Fibrillation / drug therapy*
  • Atrial Fibrillation / mortality
  • Atrial Fibrillation / physiopathology
  • Atrial Flutter / blood
  • Atrial Flutter / drug therapy*
  • Atrial Flutter / mortality
  • Atrial Flutter / physiopathology
  • Biomarkers / blood
  • Denmark
  • Diuretics / adverse effects
  • Diuretics / therapeutic use*
  • Female
  • Heart Rate / drug effects*
  • Humans
  • Hyperkalemia / blood*
  • Hyperkalemia / diagnosis
  • Hyperkalemia / mortality
  • Hypokalemia / blood*
  • Hypokalemia / diagnosis
  • Hypokalemia / mortality
  • Male
  • Potassium / blood*
  • Registries
  • Risk Assessment
  • Risk Factors
  • Time Factors
  • Treatment Outcome

Substances

  • Anti-Arrhythmia Agents
  • Biomarkers
  • Diuretics
  • Potassium