{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T14:23:38Z","timestamp":1787235818878,"version":"build-2736575974"},"reference-count":33,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2020,1,9]],"date-time":"2020-01-09T00:00:00Z","timestamp":1578528000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"},{"start":{"date-parts":[[2020,1,9]],"date-time":"2020-01-09T00:00:00Z","timestamp":1578528000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2020,8,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>To assess the prognostic value of mineralocorticoid receptor antagonist (MRA) initiation and change in serum potassium (K+) during follow-up in patients post-acute myocardial infarction with left ventricular dysfunction or chronic heart failure (HF) and reduced ejection fraction (HFrEF).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>Risk scores for predicting cardiovascular death (primary outcome), hospitalization for HF and all-cause death were developed. K+ and other relevant time-updated clinical and biological variables were added to conventional prognostic factors when constructing these new models. EPHESUS (n = 6632) was the derivation cohort, while EMPHASIS-HF (chronic HF, n = 2737) was used as external validation cohort. The final cardiovascular death risk score included medical history, clinical and biological parameters (e.g. K+, below or above the normal range of 4\u20135\u2009mmol\/L, estimated glomerular filtration rate, and anaemia), as well as aspects of treatment (any diuretic usage, MRA use or discontinuation, and beta-blocker use). The risk score performed well in both the derivation and validation cohorts and outperformed the MAGGIC score. A web-based calculator was created to allow easy determination of the risk score (http:\/\/cic-p-nancy.fr\/CardiovascularriskscoreCalculator\/).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Adding time-updated variables, including K+ and MRA treatment, improved risk prediction of cardiovascular death (on top of the MAGGIC score) in patients with HF eligible for renin\u2013angiotensin system inhibitors and MRA therapy. This new risk score including MRA usage and K+ may be of value in helping physicians to better use MRAs, avoid unnecessary and potentially detrimental permanent discontinuations, and therefore improving cardiovascular outcomes in patients with chronic HFrEF or HF after acute myocardial infarction with left ventricular dysfunction.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ejhf.1724","type":"journal-article","created":{"date-parts":[[2020,1,10]],"date-time":"2020-01-10T01:47:47Z","timestamp":1578620867000},"page":"1402-1411","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":29,"title":["Cardiovascular Risk Associated with Serum Potassium in the Context of Mineralocorticoid Receptor Antagonist Use in Patients with Heart Failure and Left Ventricular Dysfunction"],"prefix":"10.1093","volume":"22","author":[{"given":"Patrick","family":"Rossignol","sequence":"first","affiliation":[{"name":"Universit\u00e9 de Lorraine, Inserm, Centre d\u2019Investigations Cliniques- Plurith\u00e9matique 14-33, and Inserm U1116, CHRU de Nancy, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists) , Nancy ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"Duarte","sequence":"additional","affiliation":[{"name":"Universit\u00e9 de Lorraine, Inserm, Centre d\u2019Investigations Cliniques- Plurith\u00e9matique 14-33, and Inserm U1116, CHRU de Nancy, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists) , Nancy ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Girerd","sequence":"additional","affiliation":[{"name":"Universit\u00e9 de Lorraine, Inserm, Centre d\u2019Investigations Cliniques- Plurith\u00e9matique 14-33, and Inserm U1116, CHRU de Nancy, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists) , Nancy ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moez","family":"Karoui","sequence":"additional","affiliation":[{"name":"Universit\u00e9 de Lorraine, Inserm, Centre d\u2019Investigations Cliniques- Plurith\u00e9matique 14-33, and Inserm U1116, CHRU de Nancy, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists) , Nancy ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John J.V.","family":"McMurray","sequence":"additional","affiliation":[{"name":"The British Heart Foundation Cardiovascular Research Centre, University of Glasgow , Glasgow ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karl","family":"Swedberg","sequence":"additional","affiliation":[{"name":"Sahlgrenska Academy, University of Gothenburg , Gothenburg ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dirk J.","family":"van Veldhuisen","sequence":"additional","affiliation":[{"name":"University of Groningen, University Medical Center Groningen , Groningen ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stuart","family":"Pocock","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, London School of Hygiene & Tropical Medicine , London ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth","family":"Dickstein","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University of Bergen, Stavanger University Hospital , Stavanger ,","place":["Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Faiez","family":"Zannad","sequence":"additional","affiliation":[{"name":"Universit\u00e9 de Lorraine, Inserm, Centre d\u2019Investigations Cliniques- Plurith\u00e9matique 14-33, and Inserm U1116, CHRU de Nancy, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists) , Nancy ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bertram","family":"Pitt","sequence":"additional","affiliation":[{"name":"University of Michigan School of Medicine , Ann Arbor, MI ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,1,9]]},"reference":[{"key":"2026011721363234000_ejhf1724-bib-0001","first-page":"104","article-title":"Short-term mortality risk of serum potassium levels in hypertension: a retrospective analysis of nationwide registry data","volume":"38","author":"Krogager","year":"2017","journal-title":"Eur Heart J"},{"key":"2026011721363234000_ejhf1724-bib-0002","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1093\/ehjcvp\/pvv026","article-title":"Short-term mortality risk of serum potassium levels in acute heart failure following myocardial infarction","volume":"1","author":"Krogager","year":"2015","journal-title":"Eur Heart J Cardiovasc Pharmacother"},{"key":"2026011721363234000_ejhf1724-bib-0003","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1007\/s00392-017-1173-3","article-title":"Association between hypo- and hyperkalemia and outcome in acute heart failure patients: the role of medications","volume":"107","author":"Legrand","year":"2018","journal-title":"Clin Res Cardiol"},{"key":"2026011721363234000_ejhf1724-bib-0004","doi-asserted-by":"crossref","first-page":"2890","DOI":"10.1093\/eurheartj\/ehx460","article-title":"Associations of serum potassium levels with mortality in chronic heart failure patients","volume":"38","author":"Aldahl","year":"2017","journal-title":"Eur Heart J"},{"key":"2026011721363234000_ejhf1724-bib-0005","doi-asserted-by":"crossref","first-page":"1320","DOI":"10.1161\/CIRCULATIONAHA.117.030576","article-title":"Long-term potassium monitoring and dynamics in heart failure and risk of mortality","volume":"137","author":"Nunez","year":"2017","journal-title":"Circulation"},{"key":"2026011721363234000_ejhf1724-bib-0006","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1001\/jama.2011.1967","article-title":"Serum potassium levels and mortality in acute myocardial infarction","volume":"307","author":"Goyal","year":"2012","journal-title":"JAMA"},{"key":"2026011721363234000_ejhf1724-bib-0007","doi-asserted-by":"crossref","first-page":"2897","DOI":"10.1093\/eurheartj\/ehx537","article-title":"Serum potassium in patients with chronic heart failure: once we make a U-turn where should we go?","volume":"38","author":"Pitt","year":"2017","journal-title":"Eur Heart J"},{"key":"2026011721363234000_ejhf1724-bib-0008","doi-asserted-by":"crossref","first-page":"1535","DOI":"10.1093\/eurheartj\/ehy100","article-title":"Serum potassium and adverse outcomes across the range of kidney function: a CKD Prognosis Consortium meta-analysis","volume":"39","author":"Kovesdy","year":"2018","journal-title":"Eur Heart J"},{"key":"2026011721363234000_ejhf1724-bib-0009","doi-asserted-by":"crossref","first-page":"1309","DOI":"10.1056\/NEJMoa030207","article-title":"Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction","volume":"348","author":"Pitt","year":"2003","journal-title":"N Engl J Med"},{"key":"2026011721363234000_ejhf1724-bib-0010","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1056\/NEJMoa1009492","article-title":"Eplerenone in patients with systolic heart failure and mild symptoms","volume":"364","author":"Zannad","year":"2011","journal-title":"N Engl J Med"},{"key":"2026011721363234000_ejhf1724-bib-0011","doi-asserted-by":"crossref","first-page":"604","DOI":"10.7326\/0003-4819-150-9-200905050-00006","article-title":"A new equation to estimate glomerular filtration rate","volume":"150","author":"Levey","year":"2009","journal-title":"Ann Intern Med"},{"key":"2026011721363234000_ejhf1724-bib-0012","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1016\/j.ijcard.2014.02.034","article-title":"Incident hyperkalemia may be an independent therapeutic target in low ejection fraction heart failure patients: insights from the HEAAL study","volume":"173","author":"Rossignol","year":"2014","journal-title":"Int J Cardiol"},{"key":"2026011721363234000_ejhf1724-bib-0013","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1002\/(SICI)1097-0258(19960229)15:4<361::AID-SIM168>3.0.CO;2-4","article-title":"Multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors","volume":"15","author":"Harrell","year":"1996","journal-title":"Stat Med"},{"key":"2026011721363234000_ejhf1724-bib-0014","first-page":"46","article-title":"The Seattle Post Myocardial Infarction Model (SPIM): prediction of mortality after acute myocardial infarction with left ventricular dysfunction","volume":"3","author":"Ketchum","year":"2014","journal-title":"Eur Heart J Acute Cardiovasc Care"},{"key":"2026011721363234000_ejhf1724-bib-0015","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1093\/oxfordjournals.aje.a113284","article-title":"A review of goodness of fit statistics for use in the development of logistic regression models","volume":"115","author":"Lemeshow","year":"1982","journal-title":"Am J Epidemiol"},{"key":"2026011721363234000_ejhf1724-bib-0016","doi-asserted-by":"crossref","first-page":"1404","DOI":"10.1093\/eurheartj\/ehs337","article-title":"Predicting survival in heart failure: a risk score based on 39 372 patients from 30 studies","volume":"34","author":"Pocock","year":"2013","journal-title":"Eur Heart J"},{"key":"2026011721363234000_ejhf1724-bib-0017","doi-asserted-by":"crossref","first-page":"1424","DOI":"10.1161\/CIRCULATIONAHA.105.584102","article-title":"The Seattle Heart Failure Model: prediction of survival in heart failure","volume":"113","author":"Levy","year":"2006","journal-title":"Circulation"},{"key":"2026011721363234000_ejhf1724-bib-0018","doi-asserted-by":"crossref","first-page":"2823","DOI":"10.1093\/eurheartj\/eht247","article-title":"The impact of eplerenone at different levels of risk in patients with systolic heart failure and mild symptoms: insight from a novel risk score for prognosis derived from the EMPHASIS-HF trial","volume":"34","author":"Collier","year":"2013","journal-title":"Eur Heart J"},{"key":"2026011721363234000_ejhf1724-bib-0019","doi-asserted-by":"crossref","first-page":"2660","DOI":"10.1161\/01.CIR.95.12.2660","article-title":"Development and prospective validation of a clinical index to predict survival in ambulatory patients referred for cardiac transplant evaluation","volume":"95","author":"Aaronson","year":"1997","journal-title":"Circulation"},{"key":"2026011721363234000_ejhf1724-bib-0020","doi-asserted-by":"crossref","first-page":"792","DOI":"10.1002\/ejhf.688","article-title":"Impact of eplerenone on cardiovascular outcomes in heart failure patients with hypokalaemia","volume":"19","author":"Rossignol","year":"2017","journal-title":"Eur J Heart Fail"},{"key":"2026011721363234000_ejhf1724-bib-0021","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1161\/CIRCHEARTFAILURE.113.000792","article-title":"Incidence, determinants, and prognostic significance of hyperkalemia and worsening renal function in patients with heart failure receiving the mineralocorticoid receptor antagonist eplerenone or placebo in addition to optimal medical therapy: results from the Eplerenone in Mild Patients Hospitalization and Survival Study in Heart Failure (EMPHASIS-HF)","volume":"7","author":"Rossignol","year":"2014","journal-title":"Circ Heart Fail"},{"key":"2026011721363234000_ejhf1724-bib-0022","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1517\/14740338.2016.1163335","article-title":"The safety of mineralocorticoid receptor antagonists (MRAs) in patients with heart failure","volume":"15","author":"Pitt","year":"2016","journal-title":"Expert Opin Drug Saf"},{"key":"2026011721363234000_ejhf1724-bib-0023","doi-asserted-by":"crossref","first-page":"1173","DOI":"10.1093\/eurjhf\/hft134","article-title":"Are hospitalized or ambulatory patients with heart failure treated in accordance with European Society of Cardiology guidelines? Evidence from 12,440 patients of the ESC Heart Failure Long-Term Registry","volume":"15","author":"Maggioni","year":"2013","journal-title":"Eur J Heart Fail"},{"key":"2026011721363234000_ejhf1724-bib-0024","doi-asserted-by":"crossref","DOI":"10.1161\/CIR.0000000000000664","article-title":"Cardiorenal syndrome: classification, pathophysiology, diagnosis, and treatment strategies: a scientific statement from the American Heart Association","volume":"139","author":"Rangaswami","year":"2019","journal-title":"Circulation"},{"key":"2026011721363234000_ejhf1724-bib-0025","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.116.005428","article-title":"Hyperkalemia after initiating renin-angiotensin system blockade: the Stockholm Creatinine Measurements (SCREAM) project","volume":"6","author":"Bandak","year":"2017","journal-title":"J Am Heart Assoc"},{"key":"2026011721363234000_ejhf1724-bib-0026","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1002\/cpt.746","article-title":"Impact of hyperkalemia and worsening renal function on the use of renin angiotensin aldosterone system inhibitors in chronic heart failure with reduced ejection fraction","volume":"102","author":"Pitt","year":"2017","journal-title":"Clin Pharmacol Ther"},{"key":"2026011721363234000_ejhf1724-bib-0027","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1038\/ki.2015.101","article-title":"Combined use of nonsteroidal anti-inflammatory drugs with diuretics and\/or renin-angiotensin system inhibitors in the community increases the risk of acute kidney injury","volume":"88","author":"Dreischulte","year":"2015","journal-title":"Kidney Int"},{"key":"2026011721363234000_ejhf1724-bib-0028","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1159\/000499669","article-title":"Community-acquired acute kidney injury as a risk factor of de novo heart failure hospitalization","volume":"9","author":"Tecson","year":"2019","journal-title":"Cardiorenal Med"},{"key":"2026011721363234000_ejhf1724-bib-0029","doi-asserted-by":"crossref","first-page":"2129","DOI":"10.1093\/eurheartj\/ehw128","article-title":"2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC","volume":"37","author":"Ponikowski","year":"2016","journal-title":"Eur Heart J"},{"key":"2026011721363234000_ejhf1724-bib-0030","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1016\/j.phrs.2016.07.032","article-title":"Potassium lowering agents: recommendations for physician and patient education, treatment reappraisal, and serial monitoring of potassium in patients with chronic hyperkalemia","volume":"118","author":"Pitt","year":"2017","journal-title":"Pharmacol Res"},{"key":"2026011721363234000_ejhf1724-bib-0031","doi-asserted-by":"crossref","first-page":"1973","DOI":"10.1001\/jama.2015.11904","article-title":"Consistency of laboratory monitoring during initiation of mineralocorticoid receptor antagonist therapy in patients with heart failure","volume":"314","author":"Cooper","year":"2015","journal-title":"JAMA"},{"key":"2026011721363234000_ejhf1724-bib-0032","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1093\/ehjqcco\/qcy019","article-title":"A real-world cohort study on the quality of potassium and creatinine monitoring during initiation of mineralocorticoid receptor antagonists in patients with heart failure","volume":"4","author":"Nilsson","year":"2018","journal-title":"Eur Heart J Qual Care Clin Outcomes"},{"key":"2026011721363234000_ejhf1724-bib-0033","doi-asserted-by":"crossref","first-page":"1217","DOI":"10.1002\/ejhf.1199","article-title":"Incidence, predictors and clinical management of hyperkalaemia in new users of mineralocorticoid receptor antagonists","volume":"20","author":"Trevisan","year":"2018","journal-title":"Eur J Heart Fail"}],"container-title":["European Journal of Heart Failure"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fejhf.1724","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ejhf.1724","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ejhf.1724","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/academic.oup.com\/eurjhf\/article-pdf\/22\/8\/1402\/66111991\/eurjhf_22_8_1402.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/eurjhf\/article-pdf\/22\/8\/1402\/66111991\/eurjhf_22_8_1402.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,18]],"date-time":"2026-01-18T02:37:49Z","timestamp":1768703869000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/eurjhf\/article\/22\/8\/1402\/8385163"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,1,9]]},"references-count":33,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2020,1,9]]},"published-print":{"date-parts":[[2020,8,1]]}},"URL":"https:\/\/doi.org\/10.1002\/ejhf.1724","relation":{},"ISSN":["1388-9842","1879-0844"],"issn-type":[{"value":"1388-9842","type":"print"},{"value":"1879-0844","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2020,8]]},"published":{"date-parts":[[2020,1,9]]},"assertion":[{"value":"2019-08-06","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-11-26","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-01-09","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}