Impact of Compound Hypertonic Saline Solution on Decompensated Heart Failure

Abstract

SummaryThe aim of the present study was to evaluate the effects of hypertonic saline solution (C-HSS) with high dose furosemide on hospitalization time, readmission, and mortality in patients with New York Heart Association (NYHA) class III heart failure.Decompensated heart failure patients (NYHA III) with chronic ischemic or nonischemic cardiomyopathy and ejection fraction < 40% were divided into 2 groups in an open-label random manner: the first group received a 1-hour intravenous infusion of furosemide (100 mg) plus compound C-HSS (100 mL) twice daily and underwent serious water restriction (500 mL/day); the second group received furosemide intravenous bolus (100 mg) twice a day and water restriction (500 mL/day), without C-HSS. Both groups had normal sodium (120 mmol sodium) intake. After discharge, the two groups continued to receive 120 mmol Na/day and 500-1000 mL water/day.The first group (132 C-HSS patients) had an increase in urination, a reduction in hospitalization time (4 ± 2 versus 7 ± 2 days, P < 0.01), and a reduction in hospitalization costs (2210 RMB versus 3506 RMB, P < 0.01) compared with the second group (132 without C-HSS patients). During the follow-up period (36 ± 12 months), the first group had a significantly higher average readmission time (31.84 ± 7.58 months versus 15.60 ± 6.25 months, P < 0.01) and lower mortality rate (16.5% versus 31.9%, P < 0.01).The results suggest that periodical C-HSS administration, combined with serious water restriction and a normal sodium diet, significantly reduces the hospitalization time, readmission rate, and mortality in patients with NYHA class III HF. (Int Heart J 2017; 58: 601-607)

Congestion in heart failure: a contemporary look at physiology, diagnosis and treatment

“…Taken together, these effects would result in an increased diuretic response to decongestive therapies. Preliminary data from one group showed an increased reduction in body mass, preserved renal function and reductions in the length of hospital stay, rate of rehospitalization and mortality with the use of hypertonic saline infusion in addition to loop diuretic therapy compared with loop diuretics alone in patients with acute heart failure 126,127 . However, high quality, blinded, randomized clinical trials have not yet been performed.…”

Hyponatremia in Heart Failure: Pathogenesis and Management

“…Correction should not exceed 8 mEq/L in the first 24 hours of treatment [ 56 - 58 ]. However, the additional sodium load provided by the use of hypertonic saline in HF patients could worsen their symptoms [ 59 , 60 ]. In patients admitted with HF, the use of intravenous fluids during the first 48 hours of hospitalization has been associated with a higher risk of intubation, renal replacement therapy, and hospital mortality [ 61 ]; therefore, hypertonic saline treatment should be reserved only for patients with severe neurologic symptoms in which benefits of immediate treatment to decrease neurological dysfunction, outweigh the risk of congestion.…”

“…Importantly, even mild hyponatremia increases the risk of falls and cognitive deficits [ 62 ]. In the setting of chronic hyponatremia, plasma sodium level correction should not exceed the 8mEq/L in a 24-hour period in order to avoid the risk of osmotic demyelination syndrome (ODS) [ 59 ]. Currently, mainstay treatments of chronic hyponatremia in HF patients (hypervolemic state) with acceptable/stable kidney functions remain fluid restriction and loop diuretics [ 29 , 34 , 36 ].…”

Simultaneous Use of Hypertonic Saline and IV Furosemide for Fluid Overload: A Systematic Review and Meta-Analysis

“…The search identified 378 potentially relevant articles. Of which, 11 RCTs with 2,987 subjects were included and eligible for meta-analysis (16, 18, 19, 21–23, 25–27, 35, 36). All the screened observational studies did not meet the eligibility criteria.…”

“…The process of identifying eligible trials is provided in Figure S1 (http://links.lww.com/CCM/G522). The corresponding authors of the following seven RCTs (16, 18, 19, 21–23, 25) were contacted on two different separate occasions, without success. The kappa during the screening was substantial.…”