- Question
- Does actively raising plasma potassium to the high-normal range reduce arrhythmic events, hospitalizations and death in patients at high risk for ventricular arrhythmias?
- Design
- Multicenter, open-label, event-driven, randomized superiority trial conducted in Denmark, with 1:1 randomization of 1200 participants (600 per group). Median follow-up was 39.6 months.
- Population
- Patients with cardiovascular disease and an implantable cardioverter-defibrillator (ICD), with a baseline plasma potassium level of 4.3 mmol/L or lower.
- Intervention
- A strategy aimed at raising plasma potassium to a high-normal level (4.5 to 5.0 mmol/L) using potassium supplementation, a mineralocorticoid receptor antagonist, or both, plus dietary guidance and standard care.
- Control
- Standard care only.
- Primary outcome
- Composite of documented sustained ventricular tachycardia or appropriate ICD therapy, unplanned hospitalization (>24 hours) for arrhythmia or heart failure, or death from any cause, analyzed as time to first event.
- Results
- A primary end-point event occurred in 136 participants (22.7%; 7.3 events per 100 person-years) in the high-normal potassium group versus 175 (29.2%; 9.6 events per 100 person-years) in the standard-care group (HR 0.76; 95% CI 0.61 to 0.95; P = 0.01).
- Safety
- The incidence of hospitalization for hyperkalemia or hypokalemia was similar in the two groups.
- Conclusion
- In patients with an ICD at high risk for ventricular arrhythmias, a treatment-induced increase in plasma potassium significantly lowered the risk of the composite of appropriate ICD therapy, unplanned hospitalization for arrhythmia or heart failure, or death compared with standard care.
- Why it matters
- It provided randomized evidence that actively targeting high-normal potassium, rather than merely avoiding hypokalemia, can improve outcomes in patients at high arrhythmic risk.
Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.
Generated on October 14, 2026