Higher Potassium Levels Are Better for High-Risk Cardiac Patients

Background: Cardiovascular disease patients with potassium levels in the low-normal range (3.5 to 4.0 mmol/L) have higher risk of mortality compared to those in the high-normal range (4.5 to 5.0 mmol/L). Patients with an implantable cardioverter defibrillator (ICD) constitute an especially high-risk group. Objective: To assess the efficacy and safety of raising plasma potassium levels into the high-normal range in patients with an ICD. Design: Multicenter, open-label, event-driven, randomized superiority trial. Participants/Methods: Adults with an ICD or cardiac resynchronization therapy defibrillator (CRT-D) and a plasma potassium level of ≤4.3 mmol/L were randomized 1:1 to receive standard care or treatment designed to increase the potassium level to 4.5 to 5.0 mmol/L. Treatment consisted of advice on a high potassium diet, potassium tablets, spironolactone or eplerenone, and concurrent reduction of thiazide or loop diuretics. Patients had regular follow-up visits and potassium- more...