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IRIS
Aims: We assessed the interplay between hyperkalaemia (HK) and renin–angiotensin–aldosterone system inhibitor (RAASi) use, dose and discontinuation, and their association with all-cause or cardiovascular death in patients with chronic heart failure (HF). We hypothesized that HK-associated increased death may be related to RAASi withdrawal. Methods and results: The ESC-HFA-EORP Heart Failure Long-Term Registry was used. Among 9222 outpatients (HF with reduced ejection fraction: 60.6%, HF with mid-range ejection fraction: 22.9%, HF with preserved ejection fraction: 16.5%) from 31 countries, 16.6% had HK (≥5.0 mmol/L) at baseline. Angiotensin-converting enzyme inhibitor (ACEi) or angiotensin receptor blocker (ARB) was used in 88.3%, a mineralocorticoid receptor antagonist (MRA) in 58.7%, or a combination in 53.2%; of these, at ≥50% of target dose in ACEi: 61.8%; ARB: 64.7%; and MRA: 90.3%. At a median follow-up of 12.2 months, there were 789 deaths (8.6%). Both hypokalaemia and HK were independently. associated with higher mortality, and ACEi/ARB prescription at baseline with lower mortality. MRA prescription was not retained in the model. In multivariable analyses, HK at baseline was independently associated with MRA non-prescription at baseline and subsequent discontinuation. When considering subsequent discontinuation of RAASi (instead of baseline use), HK was no longer found associated with all-cause deaths. Importantly, all RAASi (ACEi, ARB, or MRA) discontinuations were strongly associated with mortality. Conclusions: In HF, hyper- and hypokalaemia were associated with mortality. However, when adjusting for RAASi discontinuation, HK was no longer associated with mortality, suggesting that HK may be a risk marker for RAASi discontinuation rather than a risk factor for worse outcomes.
Unravelling the interplay between hyperkalaemia, renin–angiotensin–aldosterone inhibitor use and clinical outcomes. Data from 9222 chronic heart failure patients of the ESC-HFA-EORP Heart Failure Long-Term Registry
Rossignol P.;Lainscak M.;Crespo-Leiro M. G.;Laroche C.;Piepoli M. F.;Filippatos G.;Rosano G. M. C.;Savarese G.;Anker S. D.;Seferovic P. M.;Ruschitzka F.;Coats A. J. S.;Mebazaa A.;McDonagh T.;Sahuquillo A.;Penco M.;Maggioni A. P.;Lund L. H.;Christopher Peter Gale G. B.;Branko Beleslin R. S.;Andrzej Budaj P. L.;Ovidiu Chioncel R. O.;Nikolaos Dagres D. E.;Nicolas Danchin F. R.;David Erlinge S. E.;Jonathan Emberson G. B.;Michael Glikson I. L.;Alastair Gray G. B.;Meral Kayikcioglu T. R.;Aldo Maggioni I. T.;Klaudia Vivien Nagy H. U.;Aleksandr Nedoshivin R. U.;Anna-Sonia Petronio I. T.;Jolien Roos-Hesselink N. L.;Lars Wallentin S. E.;Uwe Zeymer D. E.;Crespo-Leiro M.;Anker S.;Mebazaa A.;Coats A.;Filippatos G.;Ferrari R.;Maggioni A. P.;Piepoli M. F.;Goda A.;Diez M.;Fernandez A.;Fruhwald F.;Fazlibegovic E.;Gatzov P.;Kurlianskaya A.;Hullin R.;Christodoulides T.;Hradec J.;Nielsen O. W.;Nedjar R.;Uuetoa T.;Hassanein M.;Jimenez J. F. D.;Harjola V. P.;Logeart D.;Chumburidze V.;Tousoulis D.;Milicic D.;Merkely B.;O'Donoghue E.;Amir O.;Shotan A.;Shafie D.;Metra M.;Matsumori A.;Mirrakhimov E.;Kavoliuniene A.;Erglis A.;Vataman E.;Otljanska M.;Kostovska E. S.;DeMarco D. C.;Drozdz J.;Fonseca C.;Chioncel O.;Dekleva M.;Shkolnik E.;Dahlstrom U.;Lainscak M.;Goncalvesova E.;Temizhan A.;Estrago V.;Bajraktari G.;Auer J.;Ablasser K.;Fruhwald F.;Dolze T.;Brandner K.;Gstrein S.;Poelzl G.;Moertl D.;Reiter S.;Podczeck-Schweighofer A.;Muslibegovic A.;Vasilj M.;Fazlibegovic E.;Cesko M.;Zelenika D.;Palic B.;Pravdic D.;Cuk D.;Vitlianova K.;Katova T.;Velikov T.;Kurteva T.;Gatzov P.;Kamenova D.;Antova M.;Sirakova V.;Krejci J.;Mikolaskova M.;Spinar J.;Krupicka J.;Malek F.;Hegarova M.;Lazarova M.;Monhart Z.;Hassanein M.;Sobhy M.;El Messiry F.;El Shazly A. H.;Elrakshy Y.;Youssef A.;Moneim A. A.;Noamany M.;Reda A.;Dayem T. K. A.;Farag N.;Halawa S. I.;Hamid M. A.;Said K.;Saleh A.;Ebeid H.;Hanna R.;Aziz R.;Louis O.;Enen M. A.;Ibrahim B. S.;Nasr G.;Elbahry A.;Sobhy H.;Ashmawy M.;Gouda M.;Aboleineen W.;Bernard Y.;Luporsi P.;Meneveau N.;Pillot M.;Morel M.;Seronde M. -F.;Schiele F.;Briand F.;Delahaye F.;Damy T.;Eicher J. -C.;de Groote P.;Fertin M.;Lamblin N.;Isnard R.;Lefol C.;Thevenin S.;Hagege A.;Jondeau G.;Logeart D.;Le Marcis V.;Ly J. -F.;Coisne D.;Lequeux B.;Le Moal V.;Mascle S.;Lotton P.;Behar N.;Donal E.;Thebault C.;Ridard C.;Reynaud A.;Basquin A.;Bauer F.;Codjia R.;Galinier M.;Tourikis P.;Stavroula M.;Tousoulis D.;Stefanadis C.;Chrysohoou C.;Kotrogiannis I.;Matzaraki V.;Dimitroula T.;Karavidas A.;Tsitsinakis G.;Kapelios C.;Nanas J.;Kampouri H.;Nana E.;Kaldara E.;Eugenidou A.;Vardas P.;Saloustros I.;Patrianakos A.;Tsaknakis T.;Evangelou S.;Nikoloulis N.;Tziourganou H.;Tsaroucha A.;Papadopoulou A.;Douras A.;Polgar L.;Merkely B.;Kosztin A.;Nyolczas N.;Nagy A. C.;Halmosi R.;Elber J.;Alony I.;Shotan A.;Fuhrmann A. V.;Amir O.;Romano S.;Marcon S.;Penco M.;Di Mauro M.;Lemme E.;Carubelli V.;Rovetta R.;Metra M.;Bulgari M.;Quinzani F.;Lombardi C.;Bosi S.;Schiavina G.;Squeri A.;Barbieri A.;Di Tano G.;Pirelli S.;Ferrari R.;Fucili A.;Passero T.;Musio S.;Di Biase M.;Correale M.;Salvemini G.;Brognoli S.;Zanelli E.;Giordano A.;Agostoni P.;Italiano G.;Salvioni E.;Copelli S.;Modena M. G.;Reggianini L.;Valenti C.;Olaru A.;Bandino S.;Deidda M.;Mercuro G.;Dessalvi C. C.;Marino P. N.;Di Ruocco M. V.;Sartori C.;Piccinino C.;Parrinello G.;Licata G.;Torres D.;Giambanco S.;Busalacchi S.;Arrotti S.;Novo S.;Inciardi R. M.;Pieri P.;Chirco P. R.;Galifi M. A.;Teresi G.;Buccheri D.;Minacapelli A.;Veniani M.;Frisinghelli A.;Priori S. G.;Cattaneo S.;Opasich C.;Gualco A.;Pagliaro M.;Mancone M.;Fedele F.;Cinque A.;Vellini M.;Scarfo I.;Romeo F.;Ferraiuolo F.;Sergi D.;Anselmi M.;Melandri F.;Leci E.;Iori E.;Bovolo V.;Pidello S.;Frea S.;Bergerone S.;Botta M.;Canavosio F. G.;Gaita F.;Merlo M.;Cinquetti M.;Sinagra G.;Ramani F.;Fabris E.;Stolfo D.;Artico J.;Miani D.;Fresco C.;Daneluzzi C.;Proclemer A.;Cicoira M.;Zanolla L.;Marchese G.;Torelli F.;Vassanelli C.;Voronina N.;Erglis A.;Tamakauskas V.;Smalinskas V.;Karaliute R.;Petraskiene I.;Kazakauskaite E.;Rumbinaite E.;Kavoliuniene A.;Vysniauskas V.;Brazyte-Ramanauskiene R.;Petraskiene D.;Stankala S.;Switala P.;Juszczyk Z.;Sinkiewicz W.;Gilewski W.;Pietrzak J.;Orzel T.;Kasztelowicz P.;Kardaszewicz P.;Lazorko-Piega M.;Gabryel J.;Mosakowska K.;Bellwon J.;Rynkiewicz A.;Raczak G.;Lewicka E.;Dabrowska-Kugacka A.;Bartkowiak R.;Sosnowska-Pasiarska B.;Wozakowska-Kaplon B.;Krzeminski A.;Zabojszcz M.;Mirek-Bryniarska E.;Grzegorzko A.;Bury K.;Nessler J.;Zalewski J.;Furman A.;Broncel M.;Poliwczak A.;Bala A.;Zycinski P.;Rudzinska M.;Jankowski L.;Kasprzak J. D.;Michalak L.;Soska K. W.;Drozdz J.;Huziuk I.;Retwinski A.;Flis P.;Weglarz J.;Bodys A.;Grajek S.;Kaluzna-Oleksy M.;Straburzynska-Migaj E.;Dankowski R.;Szymanowska K.;Grabia J.;Szyszka A.;Nowicka A.;Samcik M.;Wolniewicz L.;Baczynska K.;Komorowska K.;Poprawa I.;Komorowska E.;Sajnaga D.;Zolbach A.;Dudzik-Plocica A.;Abdulkarim A. -F.;Lauko-Rachocka A.;Kaminski L.;Kostka A.;Cichy A.;Ruszkowski P.;Splawski M.;Fitas G.;Szymczyk A.;Serwicka A.;Fiega A.;Zysko D.;Krysiak W.;Szabowski S.;Skorek E.;Pruszczyk P.;Bienias P.;Ciurzynski M.;Welnicki M.;Mamcarz A.;Folga A.;Zielinski T.;Rywik T.;Leszek P.;Sobieszczanska-Malek M.;Piotrowska M.;Kozar-Kaminska K.;Komuda K.;Wisniewska J.;Tarnowska A.;Balsam P.;Marchel M.;Opolski G.;Kaplon-Cieslicka A.;Gil R. J.;Mozenska O.;Byczkowska K.;Gil K.;Pawlak A.;Michalek A.;Krzesinski P.;Piotrowicz K.;Uzieblo-Zyczkowska B.;Stanczyk A.;Skrobowski A.;Ponikowski P.;Jankowska E.;Rozentryt P.;Polonski L.;Gadula-Gacek E.;Nowalany-Kozielska E.;Kuczaj A.;Kalarus Z.;Szulik M.;Przybylska K.;Klys J.;Prokop-Lewicka G.;Kleinrok A.;Aguiar C. T.;Ventosa A.;Pereira S.;Faria R.;Chin J.;De Jesus I.;Santos R.;Silva P.;Moreno N.;Queiros C.;Lourenco C.;Pereira A.;Castro A.;Andrade A.;Guimaraes T. O.;Martins S.;Placido R.;Lima G.;Brito D.;Francisco A. R.;Cardiga R.;Proenca M.;Araujo I.;Marques F.;Fonseca C.;Moura B.;Leite S.;Campelo M.;Silva-Cardoso J.;Rodrigues J.;Rangel I.;Martins E.;Correia A. S.;Peres M.;Marta L.;da Silva G. F.;Severino D.;Durao D.;Leao S.;Magalhaes P.;Moreira I.;Cordeiro A. F.;Ferreira C.;Araujo C.;Ferreira A.;Baptista A.;Radoi M.;Bicescu G.;Vinereanu D.;Sinescu C. -J.;Macarie C.;Popescu R.;Daha I.;Dan G. -A.;Stanescu C.;Dan A.;Craiu E.;Nechita E.;Aursulesei V.;Christodorescu R.;Otasevic P.;Seferovic P. M.;Simeunovic D.;Ristic A. D.;Celic V.;Pavlovic-Kleut M.;Lazic J. S.;Stojcevski B.;Pencic B.;Stevanovic A.;Andric A.;Simic D.;Asanin M.;Iric-Cupic V.;Jovic M.;Davidovic G.;Milanov S.;Mitic V.;Atanaskovic V.;Antic S.;Pavlovic M.;Stanojevic D.;Stoickov V.;Ilic S.;Ilic M. D.;Petrovic D.;Stojsic S.;Kecojevic S.;Dodic S.;Adic N. C.;Cankovic M.;Stojiljkovic J.;Mihajlovic B.;Radin A.;Radovanovic S.;Krotin M.;Klabnik A.;Goncalvesova E.;Pernicky M.;Murin J.;Kovar F.;Kmec J.;Semjanova H.;Strasek M.;Iskra M. S.;Ravnikar T.;Suligoj N. C.;Komel J.;Fras Z.;Jug B.;Glavic T.;Losic R.;Bombek M.;Krajnc I.;Krunic B.;Horvat S.;Kovac D.;Rajtman D.;Cencic V.;Letonja M.;Winkler R.;Valentincic M.;Melihen-Bartolic C.;Bartolic A.;Vrckovnik M. P.;Kladnik M.;Pusnik C. S.;Marolt A.;Klen J.;Drnovsek B.;Leskovar B.;Anguita M. J. F.;Page J. C. G.;Martinez F. M. S.;Andres J.;Bayes-Genis A.;Mirabet S.;Mendez A.;Garcia-Cosio L.;Roig E.;Leon V.;Gonzalez-Costello J.;Muntane G.;Garay A.;Alcade-Martinez V.;Fernandez S. L.;Rivera-Lopez R.;Puga-Martinez M.;Fernandez-Alvarez M.;Serrano-Martinez J. L.;Crespo-Leiro M.;Grille-Cancela Z.;Marzoa-Rivas R.;Blanco-Canosa P.;Paniagua-Martin M. J.;Barge-Caballero E.;Cerdena I. L.;Baldomero I. F. H.;Padron A. L.;Rosillo S. O.;Gonzalez-Gallarza R. D.;Montanes O. S.;Manjavacas A. M. I.;Conde A. C.;Araujo A.;Soria T.;Garcia-Pavia P.;Gomez-Bueno M.;Cobo-Marcos M.;Alonso-Pulpon L.;Cubero J. S.;Sayago I.;Gonzalez-Segovia A.;Briceno A.;Subias P. E.;Hernandez M. V.;Cano M. J. R.;Sanchez M. A. G.;Jimenez J. F. D.;Garrido-Lestache E. B.;Pinilla J. M. G.;de la Villa B. G.;Sahuquillo A.;Marques R. B.;Calvo F. T.;Perez-Martinez M. T.;Gracia-Rodenas M. R.;Garrido-Bravo I. P.;Pastor-Perez F.;Pascual-Figal D. A.;Molina B. D.;Orus J.;Gonzalo F. E.;Bertomeu V.;Valero R.;Martinez-Abellan R.;Quiles J.;Rodrigez-Ortega J. A.;Mateo I.;ElAmrani A.;Fernandez-Vivancos C.;Valero D. B.;Almenar-Bonet L.;Sanchez-Lazaro I. J.;Marques-Sule E.;Facila-Rubio L.;Perez-Silvestre J.;Garcia-Gonzalez P.;Ridocci-Soriano F.;Garcia-Escriva D.;Pellicer-Cabo A.;de la Fuente Galan L.;Diaz J. L.;Platero A. R.;Arias J. C.;Blasco-Peiro T.;Julve M. S.;Sanchez-Insa E.;Aured-Guallar C.;Portoles-Ocampo A.;Melin M.;Hagglund E.;Stenberg A.;Lindahl I. -M.;Asserlund B.;Olsson L.;Dahlstrom U.;Afzelius M.;Karlstrom P.;Tengvall L.;Olsson B.;Kalayci S.;Temizhan A.;Cavusoglu Y.;Gencer E.;Yilmaz M. B.;Gunes H.
2020-01-01
Abstract
Aims: We assessed the interplay between hyperkalaemia (HK) and renin–angiotensin–aldosterone system inhibitor (RAASi) use, dose and discontinuation, and their association with all-cause or cardiovascular death in patients with chronic heart failure (HF). We hypothesized that HK-associated increased death may be related to RAASi withdrawal. Methods and results: The ESC-HFA-EORP Heart Failure Long-Term Registry was used. Among 9222 outpatients (HF with reduced ejection fraction: 60.6%, HF with mid-range ejection fraction: 22.9%, HF with preserved ejection fraction: 16.5%) from 31 countries, 16.6% had HK (≥5.0 mmol/L) at baseline. Angiotensin-converting enzyme inhibitor (ACEi) or angiotensin receptor blocker (ARB) was used in 88.3%, a mineralocorticoid receptor antagonist (MRA) in 58.7%, or a combination in 53.2%; of these, at ≥50% of target dose in ACEi: 61.8%; ARB: 64.7%; and MRA: 90.3%. At a median follow-up of 12.2 months, there were 789 deaths (8.6%). Both hypokalaemia and HK were independently. associated with higher mortality, and ACEi/ARB prescription at baseline with lower mortality. MRA prescription was not retained in the model. In multivariable analyses, HK at baseline was independently associated with MRA non-prescription at baseline and subsequent discontinuation. When considering subsequent discontinuation of RAASi (instead of baseline use), HK was no longer found associated with all-cause deaths. Importantly, all RAASi (ACEi, ARB, or MRA) discontinuations were strongly associated with mortality. Conclusions: In HF, hyper- and hypokalaemia were associated with mortality. However, when adjusting for RAASi discontinuation, HK was no longer associated with mortality, suggesting that HK may be a risk marker for RAASi discontinuation rather than a risk factor for worse outcomes.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11697/145822
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simulazione ASN
Il report seguente simula gli indicatori relativi alla propria produzione scientifica in relazione alle soglie ASN 2023-2025 del proprio SC/SSD. Si ricorda che il superamento dei valori soglia (almeno 2 su 3) è requisito necessario ma non sufficiente al conseguimento dell'abilitazione. La simulazione si basa sui dati IRIS e sugli indicatori bibliometrici alla data indicata e non tiene conto di eventuali periodi di congedo obbligatorio, che in sede di domanda ASN danno diritto a incrementi percentuali dei valori. La simulazione può differire dall'esito di un’eventuale domanda ASN sia per errori di catalogazione e/o dati mancanti in IRIS, sia per la variabilità dei dati bibliometrici nel tempo. Si consideri che Anvur calcola i valori degli indicatori all'ultima data utile per la presentazione delle domande.
La presente simulazione è stata realizzata sulla base delle specifiche raccolte sul tavolo ER del Focus Group IRIS coordinato dall’Università di Modena e Reggio Emilia e delle regole riportate nel DM 589/2018 e allegata Tabella A. Cineca, l’Università di Modena e Reggio Emilia e il Focus Group IRIS non si assumono alcuna responsabilità in merito all’uso che il diretto interessato o terzi faranno della simulazione. Si specifica inoltre che la simulazione contiene calcoli effettuati con dati e algoritmi di pubblico dominio e deve quindi essere considerata come un mero ausilio al calcolo svolgibile manualmente o con strumenti equivalenti.
