Impact of a pharmacist-based multidimensional intervention aimed at decreasing the risk of hyperkalemia in heart failure patients: A Latin-American experience

Sebastian Gallo-Bernal, Camilo A. Calixto, Nicolás Molano-González, María Paula Durán Moreno, María Fernanda Tamayo, Johanna Paola Contreras, Hector M. Medina, María Juliana Rodríguez

Resultado de la investigación: Contribución a una revistaArtículorevisión exhaustiva

Resumen

Aims: Hyperkalemia is a potentially life-threatening condition associated with the use of heart failure (HF) medications, which can lead to increased morbidity and mortality. Novel approaches for hyperkalemia prevention are needed, especially in limited-resource settings. Despite multiple studies showing the beneficial impact of pharmaceutical-counseling in several outcomes, there is a knowledge-gap regarding its impact on hyperkalemia prevention. Methods: A case-control study was performed in patients from the Adult Heart Failure Clinic Registry in our institution. Cases were selected using a definition of serum potassium K+ ≥5.5 mmol/L. To study the association between hyperkalemia and relevant risk factors, we performed a multivariate logistic regression analysis using the Least Absolute Shrinkage and Selection Operator (LASSO) method for variable selection. We also fitted a Classification and Regression Tree (CART) to establish complex interactions and effect modifiers between the selected variables. Results: We matched 483 controls (eligible HF patients without hyperkalemia) to 132 cases (eligible HF patients with hyperkalemia based on age and calendar, yielding a total sample size of 615 patients (270 females) for this study. Cases had statistically significant lower odds of receiving a pharmacist-based multidimensional intervention (PBMI) (OR 0.57; 95% CI, 0.43–0.80) or having HF with reduced ejection fraction (OR 0.56; 95% CI, 0.18–0.72). On the other hand, patients who presented hyperkalemia had statistically significant higher odds of having a history of chronic kidney disease stage 4 (OR 4.97; 95% CI, 2.24–11.01) or 5 (OR 6.73; 95% CI, 1.69–26.84) and being on enalapril at doses =40 mg/day (OR, 9.90; 95% CI 5.81–16.87). Conclusions: PBMI is a practical approach to prevent hyperkalemia in HF patients in a limited-resource setting. However, clinical trials are needed to assess its effectiveness.

Idioma originalInglés estadounidense
PublicaciónInternational Journal of Cardiology
DOI
EstadoEn prensa - abr 15 2021

All Science Journal Classification (ASJC) codes

  • Cardiología y medicina cardiovascular

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