Impact of a pharmacist-based multidimensional intervention aimed at decreasing the risk of hyperkalemia in heart failure patients: A Latin-American experience

Hyperkalemia is a potentially life-threatening condition associated with the use of heart failure (HF) medications, which can lead to increased morbidity and mortality. Novel approaches for hyperkalemia prevention are needed, especially in limited-resource settings. Despite multiple studies showing the beneficial impact of pharmaceutical-counseling in several outcomes, there is a knowledge-gap regarding its impact on hyperkalemia prevention. A case-control study was performed in patients from the Adult Heart Failure Clinic Registry in our institution. Cases were selected using a definition of serum potassium K+ ≥5.5 mmol/L. To study the association between hyperkalemia and relevant risk factors, we performed a multivariate logistic regression analysis using the Least Absolute Shrinkage and Selection Operator (LASSO) method for variable selection. We also fitted a Classification and Regression Tree (CART) to establish complex interactions and effect modifiers between the selected variables. We matched 483 controls (eligible HF patients without hyperkalemia) to 132 cases (eligible HF patients with hyperkalemia based on age and calendar, yielding a total sample size of 615 patients (270 females) for this study. Cases had statistically significant lower odds of receiving a pharmacist-based multidimensional intervention (PBMI) (OR 0.57; 95% CI, 0.43–0.80) or having HF with reduced ejection fraction (OR 0.56; 95% CI, 0.18–0.72). On the other hand, patients who presented hyperkalemia had statistically significant higher odds of having a history of chronic kidney disease stage 4 (OR 4.97; 95% CI, 2.24–11.01) or 5 (OR 6.73; 95% CI, 1.69–26.84) and being on enalapril at doses =40 mg/day (OR, 9.90; 95% CI 5.81–16.87). PBMI is a practical approach to prevent hyperkalemia in HF patients in a limited-resource setting. However, clinical trials are needed to assess its effectiveness. [Display omitted] •Hyperkalemia is a potentially life-threatening condition associated with the use of heart failure medications.•Hyperkalemia directly impacts clinical outcomes by increasing morbidity and mortality.•Hyperkalemia limits the usage of Guideline directed medical therapy and promoting suboptimal dose-titration.•Novel approaches for hyperkalemia prevention are needed, especially in limited-resource settings.•A pharmacist-based multidimensional intervention seems to be an efficient approach that could significantly improve HF patients' management in limited-resource heart centers.