Relation of Serum Sodium Level to Long-Term Outcome After a First Hospitalization for Heart Failure With Preserved Ejection Fraction

Ruşinaru, Dan; Buiciuc, Otilia; Leborgne, Laurent; Slama, Michel; Massy, Ziad A.; Tribouilloy, Christophe

doi:10.1016/j.amjcard.2008.09.091

Cited by 56 publications

(41 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

Section: Discussionsupporting

confidence: 92%

“…Similar associations were reported by previous smaller studies 13, 15, 16. For example, Rosinaru and colleagues15 showed that among 358 patients with HFpEF who survived a first hospitalization for HF during 7‐year follow‐up, hyponatremia (defined as serum sodium <136 mEq/L) was associated with an 87% higher risk of mortality (HR, 1.87; 95% CI, 1.40–2.52) compared with serum sodium >136 mEq/L. A meta‐analysis done by the Meta‐Analysis Global Group in Chronic Heart Failure (MAGGIC) showed that hyponatremia (serum sodium <135 mEq/L) at baseline is associated with a 35% higher risk of mortality during 3 years of follow‐up among 3737 patients with HFpEF (HR, 1.35; 95% CI, 1.06–1.72), compared with serum sodium >135 mEq/L 16.…”

Section: Discussionsupporting

confidence: 92%

“…However, studies on the relation between hyponatremia and long‐term clinical outcomes in HFpEF patients have yielded inconsistent results 13, 14, 15, 16. To our knowledge, previous studies have not addressed whether values of serum sodium >135 mmol/L are associated with adverse clinical outcomes in HFpEF patients in a large cohort.…”

mentioning

confidence: 98%

See 2 more Smart Citations

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

Patel

Kurgansky

Imran

et al. 2018

JAHA

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 92%

See 1 more Smart Citation

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

Patel

Kurgansky

Imran

et al. 2018

JAHA

View full text Add to dashboard Cite

show abstract

“…This is despite hyponatremia is the most common electrolyte disorder in hospitalised patients (Asadollahi et al, 2007;Patel and Balk, 2007;Ghali, 2008). However, hyponatremia is associated with poor outcome in several medical conditions, such as liver cirrhosis (Luca et al, 2007;Kim et al, 2008), congestive heart failure Rossi et al, 2007;Gotsman et al, 2008;Rusinaru et al, 2009), and infectious diseases as pneumonia (Nair et al, 2007), childhood meningitis (Chao et al, 2008), and necrotising soft-tissue infection (Yaghoubian et al, 2007). Moreover, hyponatremia has recently been associated with poor overall survival in hepatocellular carcinoma (Huo et al, 2008), gastric cancer (Kim et al, 2007), and small cell lung cancer (Gandhi and Johnson, 2006).…”

mentioning

confidence: 99%

Hyponatremia as a prognostic and predictive factor in metastatic renal cell carcinoma

et al. 2010

View full text Add to dashboard Cite

BACKGROUND: Low serum sodium has recently been associated with poor survival in localised renal cell carcinoma (RCC). We now show the prognostic effect of serum sodium in patients with metastatic RCC (mRCC). METHODS: Cohort A comprised 120 consecutive patients with mRCC receiving subcutaneous, low-dose interleukin-2 and interferon-a. Hyponatremia was assessed in univariate and multivariate analyses. An independent cohort of another 120 patients with mRCC was used for validation (cohort B). RESULTS: In cohort A, estimated 5-year survival was 15% and median survival was 15.1 months. Serum sodium ranged between 126 and 144 mM. Twenty-four patients (20%) had serum sodium levels below normal range (o136 mM). In multivariate analysis, significant independent risk factors for short survival were low serum sodium (P ¼ 0.014), high neutrophils (P ¼ 0.018), lactate dehydrogenase 41.5 upper normal level (P ¼ 0.002), and number of metastatic sites ( þ 3) (P ¼ 0.003). In cohort B, serum sodium ranged between 128 and 146 mM. Seventeen patients (14%) had sodium levels below normal range. In multivariate analysis, serum sodium was validated as an independent prognostic factor (P ¼ 0.001). A significant association between lack of response and hyponatremia was observed in both cohorts (P ¼ 0.003 and P ¼ 0.02, respectively). CONCLUSION: Low serum sodium is a new, validated, independent prognostic, and predictive factor in patients with mRCC.

show abstract

“…Nearly half of the study population had preserved left ventricular ejection fraction (LVEF), suggestingthat presence of hyponatremiais an independent predictor of outcomes in HF patients with both preserved as well as reduced LVEF, a concept that has been confirmed by other authors. 2,3 In another study on more than 4000 patients, Lee et al demonstrated that chronic hyponatremia (defined as serum Na level <136 mEq/L) increased the 30-day mortality by 53% and the 1-year mortality by 46% in patients admitted with a primary diagnosis of HF. 4 In addition to its impact on survival, in a study on patients with…”

Section: Scope Of the Problemmentioning

confidence: 99%

Hyponatremia in Heart Failure: Revisiting Pathophysiology and Therapeutic Strategies

Kazory

2010

Clinical Cardiology

View full text Add to dashboard Cite

Hyponatremia is frequently encountered in patients with heart failure (HF), and its association with adverse outcomes is well-established in this population. While hyponatremia is an independent marker for severity of HF, it is not certain whether it has a causal impact on the progression of the disease. There are no universally accepted consensus guidelines regarding therapeutic strategies for HF-associated hyponatremia and volume overload; current societal guidelines do not address management of this complication. Whereas thiazide diuretics are known to induce or worsen hyponatremia in this setting through a number of mechanisms, loop diuretics can be considered a readily available first-line pharmacologic therapy. Consistent with pathophysiology of the disease and mechanisms of action of loop diuretics, available clinical evidence supports such an approach provided that patients can be closely monitored. Use of vasopressin receptor antagonists is an emerging therapeutic strategy in this setting, and the efficacy of these agents has so far been shown in a number of clinical studies. These agents can be reserved for patients with HF in whom initial appropriate loop diuretic therapy fails to improve serum sodium levels. Scope of the ProblemHyponatremia, the most common electrolyte abnormality in hospitalized patients, is associated with increasing morbidity and mortality in various clinical settings, including heart failure (HF). In an analysis of the Organized Program To Initiate Life-Saving Treatment In Hospitalized Patients With Heart Failure (OPTIMIZE-HF) study comprising data on 47 647 admissions for acute decompensated HF (ADHF), 19.7% of the patients presented with hyponatremia, defined as a serum sodium (Na) level <135 mEq/L.1 This subgroup of patients demonstrated significantly worse outcomes and was more likely to require dialysis and inotropic agents. The in-hospital mortality rate was also significantly higher compared with those patients with normal serum Na levels (6% vs 3.2%, P < 0.0001). Nearly half of the study population had preserved left ventricular ejection fraction (LVEF), suggestingthat presence of hyponatremiais an independent predictor of outcomes in HF patients with both preserved as well as reduced LVEF, a concept that has been confirmed by other authors. 2,3 In another study on more than 4000 patients, Lee et al demonstrated that chronic hyponatremia (defined as serum Na level <136 mEq/L) increased the 30-day mortality by 53% and the 1-year mortality by 46% in patients admitted with a primary diagnosis of HF. 4 In addition to its impact on survival, in a study on patients withThe author is a consultant for Otsuka America Pharmaceutical, Inc. The author has no other funding, financial relationships, or conflicts of interest to disclose. a discharge diagnosis of HF in 49 US academic medical centers, hyponatremia was shown to significantly increase the hospital length of stay. 5 HF being the most common reason for hospitalization in patients age >65 years, and with an annual cost exceedi...

show abstract

Relation of Serum Sodium Level to Long-Term Outcome After a First Hospitalization for Heart Failure With Preserved Ejection Fraction

Cited by 56 publications

References 29 publications

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

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

Hyponatremia as a prognostic and predictive factor in metastatic renal cell carcinoma

Hyponatremia in Heart Failure: Revisiting Pathophysiology and Therapeutic Strategies

Contact Info

Product

Resources

About