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The incidence, prevalence, and risk factors for hyperkalaemia reported in randomized trials of RAASis may not reflect clinical practice due to exclusion of patients with elevated serum potassium (sK+) or severe renal impairment: information on patients managed in routine clinical care is important to understanding the actual burden of hyperkalaemia. This paper reviews the available clinical epidemiology data on hyperkalaemia in HF and considers areas requiring further research. Observational studies published since 2017 that focused on hyperkalaemia, included patients with HF, and had \u22651000 participants were considered. Hyperkalaemia occurrence in HF varied widely from 7% to 39% depending on the setting, HF severity, follow-up length, and concomitant medications. Rates were lowest in patients with newly diagnosed HF and highest in patients with greater disease severity; comorbidities, such as chronic kidney disease and diabetes, and RAASi use, reflected commonly identified risk factors for hyperkalaemia in patients with HF. Hyperkalaemia was most often mild; however, from the limited data available, persistence of mild hyperkalaemia was associated with an increased risk of mortality and major adverse cardiovascular events. There were also limited data available on the progression of hyperkalaemia. Recurrence was common, occurring in one-quarter to two-fifths of hyperkalaemia cases. Despite HF guidelines recommending close monitoring of sK+, 55\u201393% of patients did not receive appropriate testing before or after initiation of RAASi or in follow-up to moderate\/severe hyperkalaemia detection. Many of the observational studies were retrospective and from a single country. There is a need for international, prospective, longitudinal, observational studies, such as the CARE-HK in HF study (NCT04864795), to understand hyperkalaemia's prevalence, incidence, and severity; to identify and characterize cases that persist, progress, and recur; to highlight the importance of sK+ monitoring when using RAASi; and to assess the impact of newer HF therapies and potassium binders in clinical practice. Data from both clinical trials and observational studies with adjustments for confounding variables will be needed to assess the contribution of hyperkalaemia to clinical outcomes.<\/jats:p>","DOI":"10.1002\/ehf2.14661","type":"journal-article","created":{"date-parts":[[2024,3,5]],"date-time":"2024-03-05T00:08:51Z","timestamp":1709597331000},"page":"1821-1840","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Epidemiology and Risk Factors for Hyperkalaemia in Heart Failure"],"prefix":"10.1093","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4472-4468","authenticated-orcid":false,"given":"Diederick E.","family":"Grobbee","sequence":"first","affiliation":[{"name":"Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht , Utrecht ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerasimos","family":"Filippatos","sequence":"additional","affiliation":[{"name":"National and Kapodistrian University of Athens School of Medicine, Athens University Hospital Attikon , Athens ,","place":["Greece"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nihar R.","family":"Desai","sequence":"additional","affiliation":[{"name":"Center for Outcomes Research and Evaluation, Yale New Haven Hospital , New Haven, CT ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew J. S.","family":"Coats","sequence":"additional","affiliation":[{"name":"Heart Research Institute , Sydney ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fausto","family":"Pinto","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Centro Hospitalar Universit\u00e1rio Lisboa Norte, CAML, CCUL@RISE, Faculdade de Medicina, Universidade de Lisboa , Lisboa ,","place":["Portugal"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe M. C.","family":"Rosano","sequence":"additional","affiliation":[{"name":"Clinical Academic Group Cardiovascular, St George's University Hospital London, UK, Cardiology , San Raffaele Cassino ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John G. F.","family":"Cleland","sequence":"additional","affiliation":[{"name":"British Heart Foundation Centre of Research Excellence, School of Cardiovascular and Metabolic Health, University of Glasgow , Glasgow ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Kammerer","sequence":"additional","affiliation":[{"name":"CSL Vifor , Redwood City, CA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio Ramirez","family":"de Arellano","sequence":"additional","affiliation":[{"name":"CSL Vifor, HEOR , Glattbrugg ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,3,4]]},"reference":[{"key":"2026012113133730700_ehf214661-bib-0001","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1007\/s11154-016-9384-x","article-title":"Updates in hyperkalemia: Outcomes and therapeutic strategies","volume":"18","author":"Kovesdy","year":"2017","journal-title":"Rev Endocr Metab Disord"},{"key":"2026012113133730700_ehf214661-bib-0002","doi-asserted-by":"publisher","first-page":"2836","DOI":"10.1016\/j.jacc.2020.04.021","article-title":"Abnormalities of potassium in heart failure: JACC state-of-the-art review","volume":"75","author":"Ferreira","year":"2020","journal-title":"J Am Coll Cardiol"},{"key":"2026012113133730700_ehf214661-bib-0003","doi-asserted-by":"publisher","first-page":"iii2","DOI":"10.1093\/ndt\/gfz206","article-title":"Hyperkalemia: Pathophysiology, risk factors and consequences","volume":"34","author":"Hunter","year":"2019","journal-title":"Nephrol Dial Transplant"},{"key":"2026012113133730700_ehf214661-bib-0004","doi-asserted-by":"publisher","first-page":"1378","DOI":"10.1002\/ejhf.1793","article-title":"Unravelling the interplay between hyperkalaemia, renin\u2013angiotensin\u2013aldosterone inhibitor use and clinical outcomes. 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