Abstract
BackgroundVarious definitions of hyperkalaemia have been used in clinical research, and data from routine clinical practice on its incidence are sparse. We aimed to establish the incidence of hyperkalaemia in patients with newly diagnosed heart failure in the UK general population using different definitions for the condition.MethodsWe conducted a large retrospective cohort study using data from The Health Improvement Network primary care database. Patients with newly diagnosed heart failure (N = 19,194) were identified and followed until the first occurrence of hyperkalaemia. Different serum potassium (K+) thresholds were evaluated as possible definitions for hyperkalaemia, and incidence rates (IRs) calculated using a final operational definition both overall and among patient sub-groups.ResultsIRs of hyperkalaemia ranged from 0.92–7.93 per 100 person-years according to the definition. Based on considerable differences in the serum K+ normal range used between practices, 2176 (11.3 %) individuals were identified with a record of hyperkalaemia using our operational definition of a proportional increase of ≥10 % above the upper bound of the normal range: IR 2.90 per 100 person-years (95 % CI 2.78–3.02) over a mean follow-up of 3.91 years. Incidence rates were higher in older patients, and in those with diabetes or renal impairment.ConclusionsHyperkalaemia is a common finding in heart failure patients in primary care, but its incidence can vary nearly ten-fold depending on its definition. Since assessment of hyperkalaemia risk is essential for therapeutic decision making in heart failure patients, this finding warrants consideration in future epidemiological studies.
Highlights
Various definitions of hyperkalaemia have been used in clinical research, and data from routine clinical practice on its incidence are sparse
Using our final selected operational definition of hyperkalaemia, we estimated incidence rates with 95 % confidence intervals (CIs) both overall and stratified by age, sex, referral/ hospitalization status at heart failure diagnosis, diabetes, prior hyperkalaemia, and degree of renal impairment
Estimated incidence rates of hyperkalaemia varied from 0.92 to 7.93 per 100 person-years according to the definition of hyperkalaemia evaluated (Table 1)
Summary
Various definitions of hyperkalaemia have been used in clinical research, and data from routine clinical practice on its incidence are sparse. We aimed to establish the incidence of hyperkalaemia in patients with newly diagnosed heart failure in the UK general population using different definitions for the condition. Population-based data from routine clinical practice focusing on the incidence of hyperkalaemia are sparse, yet are potentially attainable through the use of large population-based databases of anonymized electronic medical records (EMRs). The Health Improvement Network (THIN) [14] is one of several such databases arising from general practices throughout the United Kingdom (UK), which are increasingly being used for pharmacoepidemiological research. They enable longterm follow-up of observational cohorts, and are able to provide large samples that are often representative of the target population. The study protocol was reviewed and approved by the scientific review committee (SRC, reference number 13–030) for THIN [15]
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