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Impact of Dietary Sodium Restriction on Heart Failure Outcomes
Abstract and Figures
Background: Although sodium restriction is advised for patients with heart failure (HF), data on sodium restriction and HF outcomes are inconsistent.
Objective: We sought to evaluate the impact of sodium restriction on HF outcomes.
Methods: We analyzed data from the multi-hospital, Heart Failure Adherence and Retention Trial which enrolled 902 NYHA class II/III HF patients and followed them for a median of 36 months. Sodium intake was serially assessed by a food frequency questionnaire. Based on the mean daily sodium intake prior to the first event of death or HF hospitalization, patients were classified into sodium restricted (<2,500 mg/day) and unrestricted (≥2,500 mg/day) groups. Study groups were propensity score-matched according to plausible baseline confounders. The primary outcome was a composite of death or HF hospitalization. The secondary outcomes were cardiac death and HF hospitalization.
Results: Sodium intake data were available for 833 subjects (145 sodium restricted, 688 sodium unrestricted), of whom 260 were propensity-matched into sodium restricted (n=130) and sodium unrestricted (n=130) groups. Sodium restriction was associated with significantly higher risk of death or HF hospitalization (42.3% vs. 26.2%; hazard ratio [HR], 1.83; 95% confidence interval [CI], 1.21-2.84; P=0.004), derived from an increase in the rate of HF hospitalization (32.3% vs. 20.0%; HR, 1.82; CI, 1.11-2.96; P=0.015) and a non-significant increase in the rate of cardiac death (HR, 1.62; CI, 0.70-3.73; P=0.257) and all-cause mortality (P=0.074). Exploratory subgroup analyses suggested that sodium restriction was associated with increased risk of death or HF hospitalization in patients not receiving angiotensin converting-enzyme inhibitor or angiotensin receptor blocker (HR, 5.78; CI, 1.93-17.27; P=0.002).
Conclusions: In symptomatic patients with chronic HF, sodium restriction may have a detrimental impact on outcome. A randomized clinical trial is needed to definitively address the role of sodium restriction in HF management.
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... Até o momento, existe uma controvérsia importante sobre a dieta de sódio na população em geral e em pacientes com IC. Estudos anteriores e recentes não evidenciaram diferença no resultado e nos parâmetros metabólicos em pacientes com IC randomizados para dieta com baixo teor de sódio e controle sem redução de sódio, 23 enquanto no estudo observacional anterior, foi mostrado um resultado significativamente melhor em pacientes recebendo a dieta usual de sódio.24 Em concordância, outro estudo sobre pacientes com IC com FE cardíaca preservada mostrou que pacientes tratados com uma dieta com baixo teor de sódio apresentaram um resultado pior em comparação com pacientes sem redução de sódio,25 assim como outros relatos, mostraram resultados interessantes na manutenção do equilíbrio do volume e preservação dos valores de sódio plasmático. ...
Fundamento Poucos estudos compararam diferentes dietas de sódio (Na) associadas a altas doses de furosemida (ADF) e restrição de ingestão de líquidos (RIL) na pressão capilar pulmonar (PCP) em pacientes com insuficiência cardíaca (IC) compensada. Objetivos O estudo teve como objetivo verificar os efeitos da ADF, 120 mmol/Na/dia e RIL (1.000 ml dia) vs ADF, RIL e 80 mmol/Na/dia na PCP, durante 12 meses de acompanhamento. Métodos 289 pacientes com IC foram randomizados: O Grupo A (n = 146) recebeu 120 mmol Na/dia, RIL e 125-250 mg duas vezes ao dia de furosemida. O Grupo B (n = 143) 80 mmol Na/dia, RIL e 125-250 mg duas vezes ao dia de furosemida. As avaliações clínicas e laboratoriais foram feitas no início do estudo, semanalmente no primeiro mês, a cada 2 semanas nos 2 meses seguintes e, então, mensalmente. Os pacientes realizaram ecocardiogramas na entrada, aos 6 e 12 meses. Resultado O grupo A, durante 12 meses, manteve a diurese como no início, enquanto o grupo B apresentou redução significativa, assim como para natriurese e Na sérico; a função renal não apresentou diferença substancial no grupo A. A PCP foi estável no grupo A, enquanto aumentou no grupo B. As readmissões e mortalidade apresentaram 22 e 11 pacientes no grupo A versus 63 e 27 óbitos no grupo B (p< 0,001, p < 0,004) Conclusão Nossos dados sugerem que uma dieta moderada em Na combinada com ADF e RIL tem efeitos benéficos sobre a PCP e os resultados clínicos. Readmissões e mortalidade foram consideradas variáveis exploratórias; de fato, o estudo não teve poder estatístico suficiente para analisar o prognóstico, e os resultados tiveram que ser considerados com cautela. NCT01738659.
... Previous and recent studies evidenced no difference in outcome and metabolic parameters in HF patients randomized to low sodium diet and control without sodium reduction, 23 while in the previous observational study, was showed a significantly better outcome in patients receiving the usual sodium diet. 24 In agreement, another study regarding HF patients with cardiac EF preserved showed that patients treated with a low sodium diet showed an outcome worse in comparison with patients without sodium reduction, 25 as well as other reports, showed interesting results in maintaining volume balance and preserving plasmatic sodium values. In agreement, it was shown that patients maintaining middle sodium values had a better outcome 26 and showed that correct hydration was important to obtain a regular effective plasmatic volume with subsequent better outcomes, in HF patients receiving diuretic treatment. ...
... 30 Similarly, although sodium restriction is recommended to prevent hypervolemia, its positive effect has not been demonstrated. 31 Loop diuretics (furosemide, bumetanide, torasemide and ethacrynic acid) are the preferred diuretics in acute or chronic HF. 32 The duration of action of loop diuretics is short, lasting 2 to 3 hours and up to 6 hours for intravenous bolus and oral administration, respectively. Intravenous furosemide has greater bioavailability than oral furosemide. ...
Cardiorenal syndrome is a complex clinical condition affecting both the kidney and the heart. It is divided into 5 different subgroups according to various clinical features. However, in most clinical settings this is difficult to determine because the pathophysiology is complex and the pathways are poorly understood. Given this complex clinical situation, many challenges arise in the management of both acute and chronic cardiorenal syndrome. In this review, the definition, classification, pathophysiology and treatment of cardiorenal syndrome are examined.
... P ¼ 0.004). 6 In SODIUM-HF (Study of Di- ...
Cardiometabolic-based chronic disease (CMBCD) comprises those cardiovascular diseases (CVDs; atherosclerosis, heart failure, and atrial fibrillation) impelled by metabolic drivers (abnormal adiposity, dysglycemia, hypertension, and dyslipidemia) and the metabolic drivers themselves (adiposity-based chronic disease, dysglycemia-based chronic disease, hypertension-based chronic disease, and lipid-based chronic disease). The most current CMBCD model is based on three dimensions: metabolic drivers, stages, and personalization (via social determinants of health and transcultural factors). This chapter will focus on the CMBCD model with respect to prevention, lifestyle medicine interventions, and research gaps.
Background
Self-care is essential in adults living with heart failure (HF). The landscape of HF management has changed considerably over the past few years, and as such, we modernized an existing measure of HF self-care. The purpose of this study was to test the psychometric properties of the revised Self-Care of Heart Failure Index (SCHFI) version 8.0 using item response theory.
Methods
A cross-sectional descriptive study was designed and conducted in the United States to test the psychometric properties of the 26-item SCHFI 8.0. We used item response theory-based approaches to determine which items contributed sufficient information to our understanding of the 3 behavioral domains: self-care maintenance (ie, routine healthy behaviors), self-care monitoring (ie, monitoring for signs and symptoms), and self-care management (ie, responding to signs and symptoms when they occur). We also used classic test theory approaches to compare results between the SCHFI 8.0 and prior versions.
Results
Participants included 217 adults with HF (mean age = 43 ± 15 years; 54.4% male, 56.2% White, 58% HF with reduced ejection fraction). Based on item response theory, items providing insufficient information within each behavioral domain were identified and removed from the SCHFI 8.0 during recalibration resulting in an abbreviated 23-item measure. The SCHFI 8.0 was most reliable at middle-to-low levels of each behavioral domain. Based on classic test theory, the self-care maintenance, self-care monitoring, and self-care management domains had Cronbach α values of 0.86, 0.90, and 0.88, respectively, and the theoretical structure of the SCHFI 8.0 was confirmed with factor analysis.
Conclusions
The 23-item SCHFI 8.0 is a valid, reliable and abbreviated measure that is ready to use and freely available on the website www.self-care-measures.com.
Low-sodium salt has a protective effect on BMD and also reduces the risk of osteopenia due to elevated blood glucose. This provides a direct and effective way to improve bone health in patients with hyperglycemia.
There is no consensus on the relationship between salt type and bone mineral density (BMD). This study examined the factors affecting osteoporosis and the relationship between low-sodium salt consumption with osteoporosis based on the Substitute Salt and Stroke Study (SSaSS).
This study was a cross-sectional study and compares the prevalence and characteristics of osteoporosis and osteopenia. Multiple linear regression and restricted spline models were used to analyze the factors affecting BMD and its dose–response relationship with osteoporosis and to compare the effects of different salts.
The rates of osteoporosis and osteopenia were lower in those consuming low-sodium salt (31.11% and 38.52%) than in those consuming normal salt (38.65% and 41.10%). BMD was higher in the population consuming low-sodium salt than in that using normal salt (= 0.64, 95%CI: 0.25, 0.97). Age, gender, and blood glucose level interacted with low-sodium salt and together affected BMD. Analysis of the dose–response relationship revealed a positive linear association between elevated blood glucose and the risk of osteopenia (P for overall < 0.05, P for nonlinear = 0.77), but intake of low-sodium salt significantly reduced this risk. The risk of OP increased with age (P for overall < 0.05, P for nonlinear = 0.72); low-sodium salt intake reduced this risk, with the effect being more pronounced among individuals < 70 years old.
Low-sodium salt has a positive effect on maintaining BMD. Elevated blood glucose and age < 70 years increase the risk of osteoporosis, but use of low-sodium salt mitigates this risk.
Russian Society of Cardiology (RSC)
With the participation: National Society of Myocardial Diseases and Heart Failure, Society of Heart Failure Specialists, Russian Scientific Medical Society of Internal Medicine
Endorsed by the Research and Practical Council of the Ministry of Health of the Russian Federation (12.09.2024)
Eurasian clinical practice guidelines for dietary management of cardiovascular diseases include actual healthy diet recommendations and modern dietary approaches for prevention and treatment of cardiovascular diseases. Nutritional assessment and interventions based on pathogenesis of atherosclerosis and cardiovascular diseases are presented.
Modern nutritional and dietary recommendations for patients with arterial hypertension, coronary heart disease, chronic heart failure, heart rhythm disorders, dyslipidemia and gout are summarized in present recommendations. Particular attention is paid to the dietary management of cardiovascular patients with obesity and/or diabetes mellitus. This guide would be interesting and intended to a wide range of readers, primarily cardiologists, dietitians and nutritionists, general practitioners, endocrinologists, and medical students.
Objective: Heart failure (HF) continues to be a leading cause of hospital admissions, particularly in underserved patients. We hypothesized that providing individualized self-management support to patients and feedback on use of evidence-based HF therapies (EBT) to physicians could lead to improvements in care and decrease hospitalizations. To assess the feasibility of conducting a larger trial testing the efficacy of this dual-level intervention, we conducted the Congestive Heart failure Adherence Redesign Trial Pilot (CHART-P), a proof-of-concept, quasi-experimental, feasibility pilot study.
Setting: A large tertiary care medical centre in Chicago.
Participants: Low-income patients (<$30,000/year) hospitalized for exacerbation of systolic HF (ejection fraction ≤ 50%) and their physicians. Twenty physicians and 33 patients were enrolled, 23 patients completed the study.
Interventions: Physicians received HF guidelines and periodic individualized feedback on their adherence to EBT. Patients received HF education, support and self-management training for diet and medication adherence by a trained nurse through 11 interactive sessions over a 4-month period. Evaluations were conducted pre-enrolment and 1 month post intervention completion.
Outcome measures: Feasibility was assessed by the ability to deliver intervention to patients and physicians. Exploratory outcomes included changes in medication and sodium intake for patients and adherence to EBT for physicians.
Results: Eighty seven percent and 82% of patients received >80% of interventions at 1 month and by study completion, respectively. Median sodium intake declined (3.5 vs 2.0 g; p<0.01). There was no statistically significant change in medication adherence based on electronic pill cap monitoring or Morisky Medication Adherence Scale (MMAS); however, there was a trend towards improved adherence based on MMAS. All physicians received timely intervention.
Conclusions: This pilot study demonstrated that the protocol was feasible. It provided important insights about the need for intervention and the difficulties in treating patients with a variety of psychosocial problems that undercut their effective care.
The purpose of the study on which this article is based was to assess the validity and reliability of an instrument designed to measure quality of life. Sixty-four items applicable to both healthy subjects and dialysis patients were tested with graduate students (n = 88); six items relative to dialysis were added, and the instrument was administered to dialysis patients (n = 37). Items were based on literature review, which supported content validity. Correlations between the instrument and an overall satisfaction with life question of 0.75 (graduate students) and 0.65 (dialysis patients) supported criterion-related validity. Support for reliability was provided by test-retest correlations of 0.87 (graduate students) and 0.81 (dialysis patients) and Cronbach's alphas of 0.93 (graduate students) and 0.90 (dialysis patients).
European and American guidelines have recommended salt and fluid restriction for patients with chronic heart failure (CHF) despite scarce scientific evidence. Therefore, we investigated the effects of salt and fluid restriction in patients with CHF.
Ninety-seven stable patients in NYHA class II-IV, on optimal medication, with previous signs of fluid retention, treated with either >40 mg (NYHA III-IV) or >80 mg (NYHA II-IV) of furosemide daily were randomized to either individualized salt and fluid restriction or information given by the nurse-led heart failure clinics, e.g. be aware not to drink too much and use salt with caution, and followed for 12 weeks. Fluid was restricted to 1.5 L and salt to 5 g daily, and individualized dietary advice and support was given. The 24 h dietary recall procedure, urine collection on three consecutive days, and para-aminobenzoic acid 80 mg t.i.d. was used to assess adherence to diet and completeness of urine collection. The primary endpoint was a composite variable consisting of NYHA class, hospitalization, weight, peripheral oedema, quality of life (QoL), thirst, and diuretics.ResultsAfter 12 weeks, significantly more patients in the intervention than in the control group improved on the composite endpoint (51% vs. 16%; P < 0.001), mostly owing to improved NYHA class and leg oedema. No negative effects were seen on thirst, appetite, or QoL.
Individualized salt and fluid restriction can improve signs and symptoms of CHF with no negative effects on thirst, appetite, or QoL in patients with moderate to severe CHF and previous signs of fluid retention.