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Focusing on high-normal potassium ranges decreased the danger of arrhythmias, hospitalization for coronary heart failure or arrhythmia and dying in contrast with no intervention, in accordance with late-breaking analysis introduced in a Scorching Line session at present at ESC Congress 2025 and concurrently printed within the New England Journal of Medication.
Presenter, Physician Christian Jons from Rigshospitalet—Copenhagen College Hospital, Copenhagen, Denmark, defined the rationale for the POTCAST trial: “There is some evidence from observational studies to suggest that low plasma potassium levels are associated with increased risk of dangerous alterations in heart rhythms and that potassium levels in the upper normal level have protective effects. We conducted the POTCAST trial to assess the benefits and risks of targeting high-normal potassium levels in patients at high risk of ventricular arrhythmias with an implantable cardioverter defibrillator (ICD).”
The open label randomized managed POTCAST trial was carried out at three websites in Denmark. Eligible members had an ICD or cardiac resynchronization remedy defibrillator and had a baseline plasma potassium ≤4.3 mmol/L. Exclusion standards included renal impairment (estimated glomerular filtration fee 2) and being pregnant.
Individuals had been randomized 1:1 to a remedy routine aiming at rising plasma potassium stage to 4.5−5.0 mmol/L, utilizing dietary steering, potassium dietary supplements and/or mineralocorticoid receptor antagonist (MRA) remedy, or to straightforward care. The first endpoint was a composite of sustained ventricular tachycardia >125 bpm lasting >30 seconds, any applicable ICD remedy, unplanned hospitalization (>24 hours) attributable to arrhythmia or coronary heart failure, and all-cause mortality.
Amongst 1,200 members who had undergone randomization, median follow-up was 39.6 months. The imply age of the members was 62.7 years and 19.8% had been ladies. From imply baseline ranges of 4.01 mmol/L, plasma potassium ranges reached a imply of 4.36 mmol/L within the high-normal potassium group in contrast with 4.05 mmol/L within the management group after six months.
The first endpoint was considerably decrease within the high-normal potassium group (22.7%) than within the management group (29.2%; hazard ratio [HR] 0.76; 95% confidence interval [CI] 0.61 to 0.95; p=0.015). The impact was constant throughout prespecified subgroups, together with ischemic coronary heart illness and coronary heart failure.
Any applicable ICD remedy (shock remedy or anti-tachycardia pacing) was the principle driver of the distinction, occurring in 15.3% of members within the high-normal potassium group and 20.3% within the management group (HR 0.75; 95% CI 0.57 to 0.80). Unplanned hospitalizations for cardiac arrhythmias occurred in 6.7% of members within the high-normal group and 10.7% within the management group (HR 0.63; 95% CI 0.28 to 0.64). Unplanned hospitalizations for coronary heart failure occurred in 3.5% and 5.5% members, respectively (HR 0.62; 95% CI 0.37 to 1.11). A complete of 5.7% within the high-normal potassium group and 6.8% within the management group died (HR 0.85; 95% CI 0.54 to 1.34).
Concerning security outcomes, hospitalization attributable to very excessive (hyperkalemia) or very low (hypokalemia) potassium ranges occurred in 1% of members in each teams. An unplanned hospitalization lasting greater than 24 hours and dying from all causes occurred in 29.5% of members within the high-normal potassium group and 33.2% within the management group (HR 0.88; 95% CI 0.72 to 1.08).
Summing up, Professor Henning Bundgaard, senior writer, mentioned, “A treatment-induced improve in plasma potassium stage of roughly 0.3 mmol/L considerably decreased the arrhythmia burden with out rising the mixed danger of hyper- or hypokalemia. The advantages occurred throughout heart problems varieties and whatever the methodology used to extend potassium ranges, e.g. supplementation or MRAs.
“In a number of landmark coronary heart failure trials, the enhancements in cardiovascular outcomes seen with MRAs had been accompanied by will increase in potassium ranges. The findings of POTCAST lead us to invest that elevated potassium ranges could, no less than partially, be chargeable for MRAs’ optimistic outcomes, quite than merely being a facet impact.
“We believe the time is right to consider increasing potassium levels to the mid-to-high normal range as an inexpensive and widely available treatment strategy in patients with a broad spectrum of cardiovascular diseases associated with a high risk of ventricular arrhythmia.”
Extra info:
Christian Jøns et al, Rising the Potassium Degree in Sufferers at Excessive Danger for Ventricular Arrhythmias, New England Journal of Medication (2025). DOI: 10.1056/NEJMoa2509542
Supplied by
European Society of Cardiology
Quotation:
Rising potassium ranges can enhance outcomes in sufferers at excessive danger of ventricular arrhythmia (2025, August 29)
retrieved 29 August 2025
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