#86 Cutting out Sodium in Heart Failure – A Taste of the Evidence
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- All-cause mortality, Relative Risk (RR)=1.95 (1.66-2.29), Number Needed to Harm (NNH)=8.
- Death due to HF, RR=2.23 (1.77-2.81), NNH=10.
- Hospital readmissions due to HF, RR=2.10 (1.67-2.64), NNH=5.
- Limitations: All studies authored by one group, adherence uncertain, very high diuretic doses, and inadequate background medical therapy may limit application.
- 302 HF patients, higher sodium (>3000mg/day):2
- Improved event free survival in NYHA class I/II.
- Worsened event free survival in NYHA class III/IV.
- 182 HF patients presenting to emergency with acute decompensation were:
- No more likely to have consumed high sodium foods in the three days prior than those with unrelated symptoms.3
- 123 HF patients who consumed >2800mg sodium/day compared to lesser amounts had:
- Higher incidence of acute decompensated HF.4
- Sodium restriction in HF is based on the theory that increased activity of the reninangiotensin-aldosterone system and other neurohormones results in sodium and water retention.5
- Conversely, others suggest that sodium restriction may in fact trigger compensatory neuroendocrine responses leading to HF exacerbation.6
- Hyponatremia is a powerful predictor of poor long-term prognosis in patients with HF.7-9
- Canadian and US guidelines recommend restricted sodium intake of 2000-3000 mg/day for those with symptomatic HF, considering further restriction in those with moderate to severe HF (consensus of opinion of experts and/or small studies).10,11