{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T20:40:01Z","timestamp":1791319201197,"version":"4.3.1"},"reference-count":25,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T00:00:00Z","timestamp":1771372800000},"content-version":"vor","delay-in-days":191,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,8,11]],"date-time":"2025-08-11T00:00:00Z","timestamp":1754870400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100006484","name":"Vifor Pharma","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100006484","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100006484","name":"Vifor Pharma","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100006484","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,11,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Patients with heart failure (HF) at high risk for hyperkalaemia are underrepresented in prospective HF registries. The CARE-HK in HF registry sought to characterize prospectively the clinical profile, management, and outcomes for patients with HF at high risk of hyperkalaemia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>CARE-HK in HF was a multinational prospective registry of outpatients with HF (regardless of left ventricular ejection fraction [LVEF]) treated with an angiotensin-converting enzyme inhibitor\/angiotensin II receptor blocker\/angiotensin receptor\u2013neprilysin inhibitor (ACEI\/ARB\/ARNI) and either receiving or potential candidate for a mineralocorticoid receptor antagonist (MRA). All patients were at increased risk of hyperkalaemia, defined as hyperkalaemia at baseline, prior hyperkalaemia, or estimated glomerular filtration rate (eGFR) &amp;lt;45\u2009ml\/min\/1.73\u2009m2. Outcomes included frequency of hyperkalaemic events (defined by clinician report with associated potassium value), achievement of renin\u2013angiotensin system inhibitor (RASi) optimization (defined as \u226550% target doses for ACEI\/ARB\/ARNI and MRA), medication changes following hyperkalaemic episodes, and clinical events. Overall, 2558 patients from 111 sites across nine countries were included. Median (25th\u201375th) age was 73 (65\u201380) years, 32% were women, 61% had LVEF \u226440%, and 40% had prior laboratory evidence of hyperkalaemia. Median baseline eGFR and serum potassium were 44 (33\u201360) ml\/min\/1.73\u2009m2 and 5.0 (4.4\u20135.3) mEq\/L, respectively. Over a median follow-up of 12.3 (9.4\u201318.1) months, 29% of patients had a hyperkalaemic event, and 7% had multiple events. In characterizing treatment prescribed for most of follow-up, 29% of patients received optimal RASi\/MRA therapy, 69% received suboptimal RASi\/MRA therapy, and 3% received no RASi\/MRA. In the 30\u2009days following the first hyperkalaemic event, RASi\/MRA was down-titrated or discontinued in 3.6% of cases. Potassium binder use was low (patiromer 9.1%, sodium zirconium cyclosilicate 5.9%). Compared with patients without a hyperkalaemic event, patients experiencing a hyperkalaemic event had similar risk of all-cause mortality (hazard ratio [HR] 1.22, 95% confidence interval [CI] 0.92\u20131.62, p\u2009=\u20090.16) and a higher risk of subsequent hospitalization (HR 1.59, 95% CI 1.35\u20131.86, p\u2009&amp;lt;\u20090.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this contemporary multinational prospective registry of patients with HF at high risk for hyperkalaemia, hyperkalaemic events were common but infrequently associated with RASi\/MRA modification or potassium binder use. Fewer than one in three patients received optimal RASi\/MRA therapy for the majority of follow-up, and hyperkalaemic events were associated with higher risk of adverse clinical outcomes.<\/jats:p>\n                    <jats:p>Clinical Trial Registration: ClinicalTrials.gov \u00a0NCT04864795.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ejhf.3800","type":"journal-article","created":{"date-parts":[[2025,8,11]],"date-time":"2025-08-11T15:21:51Z","timestamp":1754925711000},"page":"2410-2421","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Management of Patients with Heart Failure at High Risk of Hyperkalaemia: The CARE-HK in HF Registry"],"prefix":"10.1093","volume":"27","author":[{"given":"Stephen J.","family":"Greene","sequence":"first","affiliation":[{"name":"Duke Clinical Research Institute , Durham, NC ,","place":["USA"]},{"name":"Division of Cardiology, Duke University School of Medicine , Durham, NC ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew J.","family":"Sauer","sequence":"additional","affiliation":[{"name":"Saint Luke's Mid America Heart Institute and University of Missouri , Kansas City, MO ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"B\u00f6hm","sequence":"additional","affiliation":[{"name":"Klinik f\u00fcr Innere Medizin III, Universit\u00e4tsklinikum des Saarlandes, Saarland University , Homburg ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Biykem","family":"Bozkurt","sequence":"additional","affiliation":[{"name":"Winters Center for Heart Failure Research, Cardiovascular Research Institute , Baylor College of Medicine, Michael E. 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