Lower serum sodium is associated with increased short-term mortality in hospitalized patients with worsening heart failure - Results from the Outcomes of a Prospective Trial of Intravenous Milrinone for Exacerbations of Chronic Heart Failure (OPTIME-CHF) study

University of North Carolina at Chapel Hill, North Carolina, United States
Circulation (Impact Factor: 14.95). 05/2005; 111(19):2454-60. DOI: 10.1161/01.CIR.0000165065.82609.3D
Source: PubMed

ABSTRACT The prognostic value of serum sodium in patients hospitalized for worsening heart failure has not been well defined.
The Outcomes of a Prospective Trial of Intravenous Milrinone for Exacerbations of Chronic Heart Failure (OPTIME-CHF) study randomized 949 patients with systolic dysfunction hospitalized for worsening heart failure to receive 48 to 72 hours of intravenous milrinone or placebo in addition to standard therapy. In a retrospective analysis, we investigated the relationship between admission serum sodium and the primary end point of days hospitalized for cardiovascular causes within 60 days of randomization, as well as the secondary end points of in-hospital mortality, 60-day mortality, and 60-day mortality/rehospitalization. The number of days hospitalized for cardiovascular causes was higher in the lowest sodium quartile: 8.0 (4.5, 18.5) versus 6 (4, 13) versus 6 (4, 11.5) versus 6 (4, 12) days (P<0.015 for comparison with the lowest quartile). Lower serum sodium was associated with higher in-hospital and 60-day mortality: 5.9% versus 1% versus 2.3% versus 2.3% (P<0.015) and 15.9% versus 6.4% versus 7.8% versus 7% (P=0.002), respectively. There was a trend toward higher mortality/rehospitalization for patients who were in the lowest sodium quartile. Multivariable-adjusted Cox proportional hazards analysis showed that serum sodium on admission, when modeled linearly, predicted increased 60-day mortality: sodium (per 3-mEq/L decrease) had a hazard ratio of 1.18 with a 95% CI of 1.03 to 1.36 (P=0.018).
In patients hospitalized for worsening heart failure, admission serum sodium is an independent predictor of increased number of days hospitalized for cardiovascular causes and increased mortality within 60 days of discharge.

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Available from: Gary Michael Felker, Dec 12, 2013
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    • "CHF severity can be measured with the symptomatic classification scale of the New York Heart Association (NYHA) [1]. Classification via NYHA scale has been proved to be a risk factor for mortality [2], [3]. Heart rate variability (HRV) is the variation over time of the period between consecutive heartbeats (RR intervals) [4] and is usually extracted from electrocardiographic signal (ECG) recorded through a noninvasive technique. "
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    • "In the Outcomes of a Prospective Trial of Intravenous Milrinone for Exacerbations of Chronic Heart Failure Study, a low serum sodium concentration upon admission to the hospital was an independent predictor of prolonged hospitalization for cardiovascular causes and of a high mortality within 60 days after discharge from the hospital [33]. In contrast to hypercholesterolemia as a predictor of death in patients suffering from coronary artery disease, a low serum total cholesterol has been associated with a marked increase in mortality in patients presenting with advanced HF. Rauchhaus et al. reported that, in patients with CHF, the chance of survival increased by 25% for each mmol/l increment in total cholesterol, independently of the etiology of HF, age, LVEF, and exercise capacity [34]. "
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    • "In the Acute and Chronic Therapeutic Impact of Vasopressin Antagonist in Chronic Heart Failure Trial (ACTIV in CHF), hyponatraemia was observed in 22% of patients at the time of admission for AHF, and predicted mortality at 60 days after discharge [12]. In the Outcomes of Prospective Trial of Intravenous Milrinone for Exacerbations of Chronic Heart Failure Study (OPTIME- CHF), patients in the lowest plasma sodium quartile had longer hospital stay and higher mortality compared to other plasma sodium quartiles [1]. Hyponatraemia on admission has been identified as one of the most important overall prognostic markers in acute heart failure risk prediction models published by Lee et al. [4] and by Felker et al. [7]. "
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