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In patients hospitalized with acute decompensated heart failure, potassium supplementation to achieve serum potassium levels above 4.0 mEq/L is common and likely is driven by fear of hypokalemia-induced cardiac arrhythmias. To examine whether low-normal potassium levels (3.0–3.9 mEq/L) in fact are associated with worse outcomes, investigators retrospectively studied ≈5000 normokalemic patients (admission potassium level, 3.5–5.0 mEq/L) hospitalized for at least 3 days for acute decompensated heart failure at 56 U.S. hospitals. Patients with average hospital serum potassium levels in the low-normal range (<4.0 mEq/L) were compared with patients with mid-normal levels (4.0–4.5 mEq/L) or high-normal levels (>4.5 mEq/L).
Patients with low-normal…