{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T20:14:23Z","timestamp":1790712863616,"version":"4.1.0"},"reference-count":20,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"16","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2008,10,14]]},"abstract":"<jats:p>\n            <jats:bold>\n              <jats:italic>Background\u2014<\/jats:italic>\n            <\/jats:bold>\n            Aldosterone blockade is recommended for patients with congestive heart failure after acute myocardial infarction complicated by left ventricular systolic dysfunction; however, the perceived risk of hyperkalemia may limit implementation of this therapeutic approach. This subanalysis examined the relationship between eplerenone, serum potassium (K\n            <jats:sup>+<\/jats:sup>\n            ), and clinical outcomes in the Eplerenone Post\u2013Acute Myocardial Infarction Heart Failure Efficacy and Survival Study (EPHESUS).\n          <\/jats:p>\n          <jats:p>\n            <jats:bold>\n              <jats:italic>Methods and Results\u2014<\/jats:italic>\n            <\/jats:bold>\n            Hospitalized patients with congestive heart failure after acute myocardial infarction complicated by left ventricular systolic dysfunction (left ventricular ejection fraction \u226440%) treated with standard therapy were randomized 3 to 14 days after the acute myocardial infarction to additional treatment with eplerenone (25 to 50 mg\/d; n=3319) or placebo (n=3313). Patients were excluded if baseline K\n            <jats:sup>+<\/jats:sup>\n            was &gt;5.0 mEq\/L or serum creatinine was &gt;2.5 mg\/dL. In patients receiving standard therapy, the addition of eplerenone resulted in a 4.4% absolute increase in the incidence of K\n            <jats:sup>+<\/jats:sup>\n            &gt;5.5 mEq\/L, a 1.6% increase of K\n            <jats:sup>+<\/jats:sup>\n            \u22656.0 mEq\/L, and a 4.7% absolute decrease in hypokalemia (K\n            <jats:sup>+<\/jats:sup>\n            &lt;3.5 mEq\/L). Four independent baseline predictors of hyperkalemia (defined as \u22656.0 mEq\/L) were identified: potassium (K\n            <jats:sup>+<\/jats:sup>\n            greater than the median; 4.3 mEq\/L), estimated glomerular filtration rate (\u226460 mL \u00b7 min\n            <jats:sup>\u22121<\/jats:sup>\n            \u00b7 1.73 m\n            <jats:sup>\u22122<\/jats:sup>\n            ), history of diabetes mellitus, and prior use of antiarrhythmic agents. None of these independent baseline risk factors significantly impacted the cardiovascular benefit of eplerenone for reducing all-cause mortality.\n          <\/jats:p>\n          <jats:p>\n            <jats:bold>\n              <jats:italic>Conclusions\u2014<\/jats:italic>\n            <\/jats:bold>\n            Use of selective aldosterone blockade with eplerenone within the dose range of 25 to 50 mg\/d in post\u2013acute myocardial infarction patients with heart failure and left ventricular systolic dysfunction who are treated with standard therapy improves outcomes without an excess of risk of hyperkalemia (\u22656.0 mEq\/L) when periodic monitoring of serum K\n            <jats:sup>+<\/jats:sup>\n            is instituted.\n          <\/jats:p>","DOI":"10.1161\/circulationaha.108.778811","type":"journal-article","created":{"date-parts":[[2008,9,30]],"date-time":"2008-09-30T00:55:04Z","timestamp":1222736104000},"page":"1643-1650","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":199,"title":["Serum Potassium and Clinical Outcomes in the Eplerenone Post\u2013Acute Myocardial Infarction Heart Failure Efficacy and Survival Study (EPHESUS)"],"prefix":"10.1161","volume":"118","author":[{"given":"Bertram","family":"Pitt","sequence":"first","affiliation":[{"name":"From the University of Michigan School of Medicine (B.P.), Ann Arbor; University of Chicago (G.B.), Pritzker School of Medicine, Chicago, Ill; Complutense University (L.M.R.), Madrid, Spain; and Pfizer Inc (L.D., R.M.), New York, NY."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"Bakris","sequence":"additional","affiliation":[{"name":"From the University of Michigan School of Medicine (B.P.), Ann Arbor; University of Chicago (G.B.), Pritzker School of Medicine, Chicago, Ill; Complutense University (L.M.R.), Madrid, Spain; and Pfizer Inc (L.D., R.M.), New York, NY."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis M.","family":"Ruilope","sequence":"additional","affiliation":[{"name":"From the University of Michigan School of Medicine (B.P.), Ann Arbor; University of Chicago (G.B.), Pritzker School of Medicine, Chicago, Ill; Complutense University (L.M.R.), Madrid, Spain; and Pfizer Inc (L.D., R.M.), New York, NY."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenzo","family":"DiCarlo","sequence":"additional","affiliation":[{"name":"From the University of Michigan School of Medicine (B.P.), Ann Arbor; University of Chicago (G.B.), Pritzker School of Medicine, Chicago, Ill; Complutense University (L.M.R.), Madrid, Spain; and Pfizer Inc (L.D., R.M.), New York, NY."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robin","family":"Mukherjee","sequence":"additional","affiliation":[{"name":"From the University of Michigan School of Medicine (B.P.), Ann Arbor; University of Chicago (G.B.), Pritzker School of Medicine, Chicago, Ill; Complutense University (L.M.R.), Madrid, Spain; and Pfizer Inc (L.D., R.M.), New York, NY."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_1_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa030207"},{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.cir.0000134791.68010.fa"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehi204"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa040135"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(02)02694-3"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2005.06.010"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1023\/A:1011119003788"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-139-2-200307150-00013"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-145-4-200608150-00004"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9343(01)00642-8"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfg295"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199909023411001"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2710.2003.00491.x"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cardfail.2006.01.003"},{"key":"e_1_3_2_15_2","first-page":"261A.","volume":"47","year":"2006","unstructured":"Hanna MA, Sumodi V, Fagnilli K. The safe use of aldosterone antagonists in patients with chronic heart failure and associated chronic kidney disease facilitated by a protocol in an outpatient clinic. J Am Coll Cardiol. 2006; 47 (suppl A): 261A. Abstract.","journal-title":"J Am Coll Cardiol"},{"key":"e_1_3_2_16_2","first-page":"277.","volume":"26","year":"2005","unstructured":"Wilcox R, Ambrosioni E, Patni R, Koren A, Mukherjee R, Pitt B. Effect of eplerenone in patients with normal renal function and mild renal insufficiency: results from the EPHESUS Trial. Eur Heart J. 2005; 26: 277. Abstract.","journal-title":"Eur Heart J"},{"key":"e_1_3_2_17_2","first-page":"II-466.","volume":"114","year":"2006","unstructured":"Delgado-Almeida A, Delgado-Leon C. Changes in plasma ionized calcium and RBC K content in severe hyperkalemia: new electrocardiographic concept. Circulation. 2006; 114 (suppl II): II-466. Abstract.","journal-title":"Circulation"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2006.12.001"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1161\/circ.98.15.1510"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2003.06.021"}],"container-title":["Circulation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/CIRCULATIONAHA.108.778811","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T06:02:00Z","timestamp":1715580120000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCULATIONAHA.108.778811"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2008,10,14]]},"references-count":20,"journal-issue":{"issue":"16","published-print":{"date-parts":[[2008,10,14]]}},"alternative-id":["10.1161\/CIRCULATIONAHA.108.778811"],"URL":"https:\/\/doi.org\/10.1161\/circulationaha.108.778811","relation":{},"ISSN":["0009-7322","1524-4539"],"issn-type":[{"value":"0009-7322","type":"print"},{"value":"1524-4539","type":"electronic"}],"subject":[],"published":{"date-parts":[[2008,10,14]]},"assertion":[{"value":"2008-09-29","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}