Prognostic Significance of Baseline Serum Sodium in Heart Failure With Preserved Ejection Fraction

Abstract

BackgroundThe purpose of this study was to evaluate the relationship between serum sodium at the time of diagnosis and long term clinical outcomes in a large national cohort of patients with heart failure with preserved ejection fraction.Methods and ResultsWe studied 25 440 patients with heart failure with preserved ejection fraction treated at Veterans Affairs medical centers across the United States between 2002 and 2012. Serum sodium at the time of heart failure diagnosis was analyzed as a continuous variable and in categories as follows: low (115.00–134.99 mmol/L), low‐normal (135.00–137.99 mmol/L), referent group (138.00–140.99 mmol/L), high normal (141.00–143.99 mmol/L), and high (144.00–160.00 mmol/L). Multivariable Cox regression and negative binomial regression were performed to estimate hazard ratios (95% confidence interval [CI]) and incidence density ratios (95% CI) for the associations of serum sodium with mortality and hospitalizations (heart failure and all‐cause), respectively. The average age of patients was 70.8 years, 96.2% were male, and 14% were black. Compared with the referent group, low, low‐normal, and high sodium values were associated with 36% (95% CI, 28%–44%), 6% (95% CI, 1%–12%), and 9% (95% CI, 1%–17%) higher risk of all‐cause mortality, respectively. Low and low‐normal serum sodium were associated with 48% (95% CI, 10%–100%) and 38% (95% CI, 8%–77%) higher risk of number of days of heart failure hospitalizations per year, and with 44% (95% CI, 32%–56%) and 18% (95% CI, 10%–27%) higher risk of number of days of all‐cause hospitalizations per year, respectively.ConclusionsBoth elevated and reduced serum sodium, including values currently considered within normal range, are associated with adverse outcomes in patients with heart failure with preserved ejection fraction.

Sodium Intake and Heart Failure

“…A meta-analysis of HF patients showed that low serum sodium values are associated with an increased risk of mortality [ 72 ]. We have previously shown in a national Veterans Affairs database study of 25,540 HFpEF patients that a J-shaped relationship is observed between serum sodium levels and a higher risk of number of days of HF hospitalizations and all-cause hospitalizations per year [ 73 ]. Such a relationship exists with baseline measurements of serum sodium levels at the time of diagnosis of HF as well as during longitudinal follow-up.…”

Relationship between plasma volume and essential blood constituents in patients with heart failure and preserved ejection fraction

“…In cardiovascular diseases such as HF, electrolyte imbalances are frequently encountered and related to the excessive activation of the renin-angiotensin-aldosterone system as well as the use of specific medications (e.g. Among these, hypo-as well as hypernatremia has been related to higher risk of all-cause mortality in HFpEF patients (Patel et al, 2018). The most common electrolyte disturbances in HF patients are hyponatremia, hypokalemia and hypomagnesemia (Urso et al, 2015).…”

“…The most common electrolyte disturbances in HF patients are hyponatremia, hypokalemia and hypomagnesemia (Urso et al, 2015). Among these, hypo-as well as hypernatremia has been related to higher risk of all-cause mortality in HFpEF patients (Patel et al, 2018). Moreover, hypokalemia has been associated with greater risk of ventricular arrhythmia (Bielecka-Dabrowa et al, 2012;Pezhouman et al, 2015), a major cause of sudden death in HF patients (John et al, 2012).…”

Asociación entre hiponatremia, mortalidad y estancia hospitalaria en pacientes con falla cardíaca descompensada

“…documentaron una prevalencia de 21% en pacientes con fracción de eyección conservada (27). También se documentó que algunos pacientes que ingresaban sin hiponatremia posteriormente la presentaban en alguna de las dos mediciones posteriores; sin embargo, no se puede establecer una prevalencia definitiva de la hiponatremia intrahospitalaria, dado que no se tuvieron datos de todos los pacientes y se realizaron a lo sumo tres mediciones durante la estancia hospitalaria, sin realizarse en todos los pacientes medición de sodio el día del egreso, lo cual es importante teniendo en cuenta la dinámica de las concentraciones de sodio en sangre durante el manejo de estos pacientes.…”