{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T04:41:20Z","timestamp":1791520880048,"version":"4.3.4"},"reference-count":35,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,12,21]],"date-time":"2024-12-21T00:00:00Z","timestamp":1734739200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,12,21]],"date-time":"2024-12-21T00:00:00Z","timestamp":1734739200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100004325","name":"AstraZeneca","doi-asserted-by":"publisher","award":["ESR-20-20859"],"award-info":[{"award-number":["ESR-20-20859"]}],"id":[{"id":"10.13039\/100004325","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004325","name":"AstraZeneca","doi-asserted-by":"publisher","award":["ESR-20-20859"],"award-info":[{"award-number":["ESR-20-20859"]}],"id":[{"id":"10.13039\/100004325","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Clin Exp Med"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Inhibitors of the renin\u2013angiotensin\u2013aldosterone system (RAAS), such as ACE inhibitors (ACEi), angiotensin-II receptor blockers and mineralocorticoid receptor antagonists, reduce morbidity and mortality in hypertension, congestive heart failure and chronic kidney disease. However, their use can lead to hyperkalaemia. We examined the proportions of RAAS inhibitor (RAASi) reduction or withdrawal, across GFR strata, following hospitalisation and the effect on patient mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was a retrospective cohort study of adult patients hospitalised from 1 January2017 to 31 December2020. Biochemistry data, clinical notes and medicines use were extracted using the CogStack platform, from electronic health records. Patients were identified by creatinine measurement during hospitalisation. Hyperkalaemia was defined as potassium\u2009&gt;\u20095.0 mmol\/L, with severity categorisation. RAASi discontinuation defined as\u2009\u2265\u200948 h without administration. Mortality risk associated with RAASi cessation was assessed using Cox proportional hazards models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 129,172 patients with potassium measurements, 49,011 were hospitalised. Hyperkalaemia prevalence was 8.57% in the emergency department and 16.79% among hospitalised patients. Higher hyperkalaemia levels correlated with increased CKD and heart failure. RAASi use was more common in hyperkalaemic patients, with higher discontinuation rates during hospitalisation (36% with potassium 5\u20135.5 mmol\/L; 61% with potassium\u2009&gt;\u20096.5 mmol\/L). By discharge, 32% of patients had RAASi stopped, and 2% doses reduced. Discontinuation of RAASi was associated with 37% worse survival probability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>RAASi cessation was greater with hyperkalaemia and associated with increased mortality in hospitalised patients. Reinstitution of RAASi after hospital discharge, or alternative management of hyperkalaemia if maintained on RAASi therapy, may improve clinical outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10238-024-01531-9","type":"journal-article","created":{"date-parts":[[2024,12,21]],"date-time":"2024-12-21T08:59:27Z","timestamp":1734771567000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Impact of hyperkalaemia on renin\u2013angiotensin\u2013aldosterone (RAAS) inhibitor reduction or withdrawal following hospitalisation"],"prefix":"10.1007","volume":"25","author":[{"given":"Hugh Logan","family":"Ellis","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad","family":"Al-Agil","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip A.","family":"Kelly","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Teo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claire","family":"Sharpe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin B.","family":"Whyte","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,12,21]]},"reference":[{"issue":"5","key":"1531_CR1","doi-asserted-by":"publisher","first-page":"1027","DOI":"10.1016\/j.kint.2018.12.025","volume":"95","author":"AK Cheung","year":"2019","unstructured":"Cheung AK, Chang TI, Cushman WC, Furth SL, Ix JH, Pecoits-Filho R, Perkovic V, Sarnak MJ, Tobe SW, Tomson CRV, et al. Blood pressure in chronic kidney disease: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int. 2019;95(5):1027\u201336.","journal-title":"Kidney Int"},{"issue":"1","key":"1531_CR2","doi-asserted-by":"publisher","first-page":"e003529","DOI":"10.1161\/CIRCHEARTFAILURE.116.003529","volume":"10","author":"H Burnett","year":"2017","unstructured":"Burnett H, Earley A, Voors AA, Senni M, McMurray JJ, Deschaseaux C, Cope S. Thirty Years of Evidence on the Efficacy of Drug Treatments for Chronic Heart Failure With Reduced Ejection Fraction: A Network Meta-Analysis. Circ Heart Fail. 2017;10(1):e003529.","journal-title":"Circ Heart Fail"},{"issue":"6","key":"1531_CR3","doi-asserted-by":"publisher","first-page":"2255","DOI":"10.1093\/ndt\/gfr696","volume":"27","author":"M Evans","year":"2012","unstructured":"Evans M, Bain SC, Hogan S, Bilous RW. Collaborative Study Group p: Irbesartan delays progression of nephropathy as measured by estimated glomerular filtration rate: post hoc analysis of the Irbesartan Diabetic Nephropathy Trial. Nephrol Dial Transpl. 2012;27(6):2255\u201363.","journal-title":"Nephrol Dial Transpl"},{"issue":"5","key":"1531_CR4","doi-asserted-by":"publisher","first-page":"507","DOI":"10.1001\/jama.2013.284427","volume":"311","author":"PA James","year":"2014","unstructured":"James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, Lackland DT, LeFevre ML, MacKenzie TD, Ogedegbe O, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311(5):507\u201320.","journal-title":"JAMA"},{"issue":"16","key":"1531_CR5","doi-asserted-by":"publisher","first-page":"e147","DOI":"10.1016\/j.jacc.2013.05.019","volume":"62","author":"CW Yancy","year":"2013","unstructured":"Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, et al. 2013 ACCF\/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation\/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;62(16):e147-239.","journal-title":"J Am Coll Cardiol"},{"issue":"7","key":"1531_CR6","doi-asserted-by":"publisher","first-page":"e005428","DOI":"10.1161\/JAHA.116.005428","volume":"6","author":"G Bandak","year":"2017","unstructured":"Bandak G, Sang Y, Gasparini A, Chang AR, Ballew SH, Evans M, Arnlov J, Lund LH, Inker LA, Coresh J, et al. Hyperkalemia after initiating renin-angiotensin system blockade: the Stockholm creatinine measurements (SCREAM) project. J Am Heart Assoc. 2017;6(7):e005428.","journal-title":"J Am Heart Assoc"},{"issue":"3","key":"1531_CR7","first-page":"547","volume":"5","author":"SA Sadjadi","year":"2009","unstructured":"Sadjadi SA, McMillan JI, Jaipaul N, Blakely P, Hline SS. A comparative study of the prevalence of hyperkalemia with the use of angiotensin-converting enzyme inhibitors versus angiotensin receptor blockers. Ther Clin Risk Manag. 2009;5(3):547\u201352.","journal-title":"Ther Clin Risk Manag"},{"issue":"8","key":"1531_CR8","doi-asserted-by":"publisher","first-page":"917","DOI":"10.1001\/archinte.158.8.917","volume":"158","author":"CG Acker","year":"1998","unstructured":"Acker CG, Johnson JP, Palevsky PM, Greenberg A. Hyperkalemia in hospitalized patients: causes, adequacy of treatment, and results of an attempt to improve physician compliance with published therapy guidelines. Arch Intern Med. 1998;158(8):917\u201324.","journal-title":"Arch Intern Med"},{"issue":"4","key":"1531_CR9","doi-asserted-by":"publisher","first-page":"268","DOI":"10.1159\/000013599","volume":"20","author":"TS Ahuja","year":"2000","unstructured":"Ahuja TS, Freeman D Jr, Mahnken JD, Agraharkar M, Siddiqui M, Memon A. Predictors of the development of hyperkalemia in patients using angiotensin-converting enzyme inhibitors. Am J Nephrol. 2000;20(4):268\u201372.","journal-title":"Am J Nephrol"},{"issue":"4","key":"1531_CR10","doi-asserted-by":"publisher","first-page":"307","DOI":"10.1016\/S0002-9343(00)00496-4","volume":"109","author":"MA Perazella","year":"2000","unstructured":"Perazella MA. Drug-induced hyperkalemia: old culprits and new offenders. Am J Med. 2000;109(4):307\u201314.","journal-title":"Am J Med"},{"issue":"5","key":"1531_CR11","doi-asserted-by":"publisher","first-page":"867","DOI":"10.1001\/archinte.1987.00370050063011","volume":"147","author":"JM Rimmer","year":"1987","unstructured":"Rimmer JM, Horn JF, Gennari FJ. Hyperkalemia as a complication of drug therapy. Arch Intern Med. 1987;147(5):867\u20139.","journal-title":"Arch Intern Med"},{"issue":"3","key":"1531_CR12","doi-asserted-by":"publisher","first-page":"213","DOI":"10.1159\/000479802","volume":"46","author":"AJ Collins","year":"2017","unstructured":"Collins AJ, Pitt B, Reaven N, Funk S, McGaughey K, Wilson D, Bushinsky DA. Association of serum potassium with all-cause mortality in patients with and without heart failure, chronic kidney disease, and\/or diabetes. Am J Nephrol. 2017;46(3):213\u201321.","journal-title":"Am J Nephrol"},{"issue":"1","key":"1531_CR13","doi-asserted-by":"publisher","first-page":"90","DOI":"10.2215\/CJN.01730215","volume":"11","author":"J Luo","year":"2016","unstructured":"Luo J, Brunelli SM, Jensen DE, Yang A. Association between serum potassium and outcomes in patients with reduced kidney function. Clin J Am Soc Nephrol. 2016;11(1):90\u2013100.","journal-title":"Clin J Am Soc Nephrol"},{"issue":"22","key":"1531_CR14","doi-asserted-by":"publisher","first-page":"e012655","DOI":"10.1161\/JAHA.119.012655","volume":"8","author":"C Linde","year":"2019","unstructured":"Linde C, Bakhai A, Furuland H, Evans M, McEwan P, Ayoubkhani D, Qin L. Real-World associations of renin-angiotensin-aldosterone system inhibitor dose, Hyperkalemia, and adverse clinical outcomes in a cohort of patients with new-onset chronic kidney disease or heart failure in the United Kingdom. J Am Heart Assoc. 2019;8(22):e012655.","journal-title":"J Am Heart Assoc"},{"issue":"Suppl A","key":"1531_CR15","doi-asserted-by":"publisher","first-page":"A20","DOI":"10.1093\/eurheartj\/suy030","volume":"21","author":"S Vijayakumar","year":"2019","unstructured":"Vijayakumar S, Butler J, Bakris GL. Barriers to guideline mandated renin-angiotensin inhibitor use: focus on hyperkalaemia. Eur Heart J Suppl. 2019;21(Suppl A):A20\u20137.","journal-title":"Eur Heart J Suppl"},{"issue":"4","key":"1531_CR16","doi-asserted-by":"publisher","first-page":"e012674","DOI":"10.1136\/bmjopen-2016-012674","volume":"7","author":"P Whiting","year":"2017","unstructured":"Whiting P, Morden A, Tomlinson LA, Caskey F, Blakeman T, Tomson C, Stone T, Richards A, Savovic J, Horwood J. What are the risks and benefits of temporarily discontinuing medications to prevent acute kidney injury? A systematic review and meta-analysis. BMJ Open. 2017;7(4):e012674.","journal-title":"BMJ Open"},{"issue":"1","key":"1531_CR17","doi-asserted-by":"publisher","first-page":"E3","DOI":"10.1503\/cmaj.190952","volume":"192","author":"HL Ellis","year":"2020","unstructured":"Ellis HL, Wan B, Yeung M, Rather A, Mannan I, Bond C, Harvey C, Raja N, Dutey-Magni P, Rockwood K, et al. Complementing chronic frailty assessment at hospital admission with an electronic frailty index (FI-Laboratory) comprising routine blood test results. CMAJ. 2020;192(1):E3\u20138.","journal-title":"CMAJ"},{"key":"1531_CR18","unstructured":"Logan Ellis HS, C; Kelly, PA; Al-Agil, M; Teo, JTH; Whyte, MB. Evaluation of the performance of point-of-care potassium testing for the early Identification of hyperkalemia in hospitalised patients. UK Kidney Week Poster session 16. October 7th 2021; 2021."},{"issue":"3","key":"1531_CR19","doi-asserted-by":"publisher","first-page":"e156","DOI":"10.1111\/j.1755-5922.2010.00258.x","volume":"30","author":"MA Raebel","year":"2012","unstructured":"Raebel MA. Hyperkalemia associated with use of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers. Cardiovasc Ther. 2012;30(3):e156-166.","journal-title":"Cardiovasc Ther"},{"key":"1531_CR20","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1093\/jphsr\/rmaa004","volume":"12","author":"AA Sharma","year":"2021","unstructured":"Sharma AA, Woods SD, Fogli J, Dai D. Healthcare resource utilization and costs associated with hyperkalemia in a large managed care population. J Pharm Health Ser Res. 2021;12:35\u201341.","journal-title":"J Pharm Health Ser Res"},{"issue":"10","key":"1531_CR21","doi-asserted-by":"publisher","first-page":"2365","DOI":"10.1111\/bcp.13692","volume":"84","author":"SH Mahmoudpour","year":"2018","unstructured":"Mahmoudpour SH, Asselbergs FW, Souverein PC, de Boer A, Maitland-van der Zee AH. Prescription patterns of angiotensin-converting enzyme inhibitors for various indications: a UK population-based study. Br J Clin Pharmacol. 2018;84(10):2365\u201372.","journal-title":"Br J Clin Pharmacol"},{"issue":"11","key":"1531_CR22","doi-asserted-by":"publisher","first-page":"2220","DOI":"10.1016\/j.mayocp.2019.05.031","volume":"94","author":"Y Qiao","year":"2019","unstructured":"Qiao Y, Shin JI, Sang Y, Inker LA, Secora A, Luo S, Coresh J, Alexander GC, Jackson JW, Chang AR, et al. Discontinuation of angiotensin converting enzyme inhibitors and angiotensin receptor blockers in chronic kidney disease. Mayo Clin Proc. 2019;94(11):2220\u20139.","journal-title":"Mayo Clin Proc"},{"issue":"5","key":"1531_CR23","doi-asserted-by":"publisher","first-page":"728","DOI":"10.1053\/j.ajkd.2015.10.011","volume":"67","author":"X Xie","year":"2016","unstructured":"Xie X, Liu Y, Perkovic V, Li X, Ninomiya T, Hou W, Zhao N, Liu L, Lv J, Zhang H, et al. Renin-angiotensin system inhibitors and kidney and cardiovascular outcomes in patients with CKD: a Bayesian network meta-analysis of randomized clinical trials. Am J Kidney Dis. 2016;67(5):728\u201341.","journal-title":"Am J Kidney Dis"},{"issue":"10","key":"1531_CR24","doi-asserted-by":"publisher","first-page":"1893","DOI":"10.1093\/ndt\/gfaa300","volume":"36","author":"CP Walther","year":"2021","unstructured":"Walther CP, Winkelmayer WC, Richardson PA, Virani SS, Navaneethan SD. Renin-angiotensin system blocker discontinuation and adverse outcomes in chronic kidney disease. Nephrol Dial Transpl. 2021;36(10):1893\u20139.","journal-title":"Nephrol Dial Transpl"},{"issue":"5","key":"1531_CR25","doi-asserted-by":"publisher","first-page":"718","DOI":"10.1001\/jamainternmed.2020.0193","volume":"180","author":"Y Qiao","year":"2020","unstructured":"Qiao Y, Shin JI, Chen TK, Inker LA, Coresh J, Alexander GC, Jackson JW, Chang AR, Grams ME. Association between renin-angiotensin system blockade discontinuation and all-cause mortality among persons with low estimated glomerular filtration rate. JAMA Intern Med. 2020;180(5):718\u201326.","journal-title":"JAMA Intern Med"},{"key":"1531_CR26","doi-asserted-by":"publisher","first-page":"101751","DOI":"10.1016\/j.eclinm.2022.101751","volume":"55","author":"A Yang","year":"2023","unstructured":"Yang A, Shi M, Lau ESH, Wu H, Zhang X, Fan B, Kong APS, Luk AOY, Ma RCW, Chan JCN, et al. Clinical outcomes following discontinuation of renin-angiotensin-system inhibitors in patients with type 2 diabetes and advanced chronic kidney disease: a prospective cohort study. EClinicalMedicine. 2023;55:101751.","journal-title":"EClinicalMedicine"},{"issue":"22","key":"1531_CR27","doi-asserted-by":"publisher","first-page":"2021","DOI":"10.1056\/NEJMoa2210639","volume":"387","author":"S Bhandari","year":"2022","unstructured":"Bhandari S, Mehta S, Khwaja A, Cleland JGF, Ives N, Brettell E, Chadburn M, Cockwell P, Investigators SAT. Renin-angiotensin system inhibition in advanced chronic kidney disease. N Engl J Med. 2022;387(22):2021\u201332.","journal-title":"N Engl J Med"},{"issue":"4","key":"1531_CR28","doi-asserted-by":"publisher","first-page":"617","DOI":"10.2215\/CJN.14021118","volume":"14","author":"C Tomson","year":"2019","unstructured":"Tomson C, Tomlinson LA. Stopping RAS inhibitors to minimize AKI: More harm than good? Clin J Am Soc Nephrol. 2019;14(4):617\u20139.","journal-title":"Clin J Am Soc Nephrol"},{"key":"1531_CR29","doi-asserted-by":"publisher","first-page":"164","DOI":"10.1053\/j.ajkd.2022.01.002","volume":"80","author":"SJ Leon","year":"2022","unstructured":"Leon SJ, Whitlock R, Rigatto C, Komenda P, Bohm C, Sucha E, Bota SE, Tuna M, Collister D, Sood M, et al. Hyperkalemia-related discontinuation of renin-angiotensin-aldosterone system inhibitors and clinical outcomes in CKD: a population-based cohort study. Am J Kidney Dis. 2022;80:164\u201373.","journal-title":"Am J Kidney Dis"},{"issue":"3","key":"1531_CR30","doi-asserted-by":"publisher","first-page":"239","DOI":"10.7861\/clinmedicine.15-3-239","volume":"15","author":"R Conway","year":"2015","unstructured":"Conway R, Creagh D, Byrne DG, O\u2019Riordan D, Silke B. Serum potassium levels as an outcome determinant in acute medical admissions. Clin Med. 2015;15(3):239\u201343.","journal-title":"Clin Med"},{"issue":"2","key":"1531_CR31","doi-asserted-by":"publisher","first-page":"73","DOI":"10.15441\/ceem.16.194","volume":"4","author":"AJ Singer","year":"2017","unstructured":"Singer AJ, Thode HC Jr, Peacock WF. A retrospective study of emergency department potassium disturbances: severity, treatment, and outcomes. Clin Exp Emerg Med. 2017;4(2):73\u20139.","journal-title":"Clin Exp Emerg Med"},{"issue":"4","key":"1531_CR32","doi-asserted-by":"publisher","first-page":"e026465","DOI":"10.1136\/bmjopen-2018-026465","volume":"9","author":"K Kim","year":"2019","unstructured":"Kim K, Thomsen RW, Nicolaisen SK, Hasvold LP, Palaka E, Sorensen HT. Healthcare resource utilisation and cost associated with elevated potassium levels: a Danish population-based cohort study. BMJ Open. 2019;9(4):e026465.","journal-title":"BMJ Open"},{"key":"1531_CR33","doi-asserted-by":"publisher","first-page":"148","DOI":"10.1016\/j.resuscitation.2015.07.017","volume":"95","author":"A Truhlar","year":"2015","unstructured":"Truhlar A, Deakin CD, Soar J, Khalifa GE, Alfonzo A, Bierens JJ, Brattebo G, Brugger H, Dunning J, Hunyadi-Anticevic S, et al. European resuscitation council guidelines for resuscitation 2015: cardiac arrest in special circumstances. Resuscitation. 2015;95:148\u2013201.","journal-title":"Resuscitation"},{"issue":"6","key":"1531_CR34","doi-asserted-by":"publisher","first-page":"R225","DOI":"10.1186\/cc11872","volume":"16","author":"JN An","year":"2012","unstructured":"An JN, Lee JP, Jeon HJ, Kim DH, Oh YK, Kim YS, Lim CS. Severe hyperkalemia requiring hospitalization: predictors of mortality. Crit Care. 2012;16(6):R225.","journal-title":"Crit Care"},{"issue":"4","key":"1531_CR35","doi-asserted-by":"publisher","first-page":"310","DOI":"10.1097\/MEJ.0000000000000076","volume":"21","author":"BM Bloom","year":"2014","unstructured":"Bloom BM, Connor H, Benton S, Harris T. A comparison of measurements of sodium, potassium, haemoglobin and creatinine between an Emergency Department-based point-of-care machine and the hospital laboratory. Eur J Emerg Med. 2014;21(4):310\u20133.","journal-title":"Eur J Emerg Med"}],"container-title":["Clinical and Experimental Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10238-024-01531-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10238-024-01531-9\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10238-024-01531-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T06:52:53Z","timestamp":1764917573000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s10238-024-01531-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,21]]},"references-count":35,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["1531"],"URL":"https:\/\/doi.org\/10.1007\/s10238-024-01531-9","relation":{},"ISSN":["1591-9528"],"issn-type":[{"value":"1591-9528","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,12,21]]},"assertion":[{"value":"12 October 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 November 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 December 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"The King\u2019s College Hospital Research and Innovation Department, after review of the project, considered this as a service evaluation, rather than research. We confirmed this opinion using the HRA \u2018Is this research?\u2019 decision tool (\n                      \n                      ). We used anonymous data, at scale, at source (within the hospital IT system), and therefore, patient-level consent was not required. Approval for this approach to use of CogStack is within London\u2014South East Research Ethics Committee approval (18\/LO\/2048) 2nd January 2019. King's Electronic Patient Record Interface (KERRI) committee (project ID 20210405A) approved the project (within the boundaries of CogStack ethical approval 18\/LO\/2048) on 7th May 2021.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to publish"}}],"article-number":"16"}}