• Zubaid Rafique, Maria José Fortuny, Dick Kuo, Lukasz Szarpak, Lluís Llauger, Begoña Espinosa, Víctor Gil, Javier Jacob, Aitor Alquézar-Arbé, Juan Antonio Andueza, José Manuel Garrido, Alfons Aguirre, Marta Fuentes, Héctor Alonso, Francisco Javier Lucas-Imbernón, Carlos Bibiano, Guillermo Burillo-Putze, Julio Núñez, Wilfried Mullens, Pedro Lopez-Ayala, Christian Mueller, Pere Llorens, Frank Peacock, Òscar Miró, and ICA-SEMES Research Group.
• Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA. Electronic address: zubaidrafique@gmail.com.
• Am J Emerg Med. 2023 Aug 1; 70: 191-9.

ObjectiveBoth hyperkalemia (HK) and Acute Heart Failure (AHF) are associated with increased short-term mortality, and the management of either may exacerbate the other. As the relationship between HK and AHF is poorly described, our purpose was to determine the relationship between HK and short-term outcomes in Emergency Department (ED) AHF.MethodsThe EAHFE Registry enrolls all ED AHF patients from 45 Spanish ED and records in-hospital and post-discharge outcomes. Our primary outcome was all-cause in-hospital death, with secondary outcomes of prolonged hospitalization (>7 days) and 7-day post-discharge adverse events (ED revisit, hospitalization, or death). Associations between serum potassium (sK) and outcomes were explored using logistic regression by restricted cubic spline (RCS) curves, with sK =4.0 mEq/L as the reference, adjusting by age, sex, comorbidities, patient baseline status and chronic treatments. Interaction analyses were performed for the primary outcome.ResultsOf 13,606 ED AHF patients, the median (IQR) age was 83 (76-88) years, 54% were women, and the median (IQR) sK was 4.5 mEq/L (4.3-4.9) with a range of 4.0-9.9 mEq/L. In-hospital mortality was 7.7%, with prolonged hospitalization in 35.9%, and a 7-day post-discharge adverse event rate of 8.7%. Adjusted in-hospital mortality increased steadily from sK ≥4.8 (OR = 1.35, 95% CI = 1.01-1.80) to sK = 9.9 (8.41, 3.60-19.6). Non-diabetics with elevated sK had higher odds of death, while chronic treatment with mineralocorticoid-receptor antagonists exhibited a mixed effect. Neither prolonged hospitalization nor post-discharge adverse events was associated with sK.ConclusionIn ED AHF, initial sK >4.8 mEq/L was independently associated with in-hospital mortality, suggesting that this cohort may benefit from aggressive HK treatment.Copyright © 2023 Elsevier Inc. All rights reserved.

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