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Improvement in hyponatremia during hospitalization for worsening heart failure is associated with improved outcomes: insights from the Acute and Chronic Therapeutic Impact of a Vasopressin Antagonist in Chronic Heart Failure (ACTIV in CHF) trial.
Acute Card Care. 2007; 9(2):82-6.AC

Abstract

BACKGROUND

Hyponatremia predicts poor outcome in patients with acute heart failure syndromes. This study evaluated the relationship between baseline serum sodium, change in serum sodium, and 60-day mortality in hospitalized heart failure patients.

METHODS

A post-hoc analysis of the ACTIV in CHF trial was performed. ACTIV in CHF randomized 319 patients hospitalized for worsening heart failure to placebo or one of three tolvaptan doses. Cox proportional hazards regression-analysis was used to explore the relationship between baseline hyponatremia, sodium change during the hospitalization, and 60-day mortality.

RESULTS

Hyponatremia was observed in 69 patients (21.6%). After covariate adjustment, baseline hyponatremia was a statistically significant predictor of 60-day mortality (P = 0.0016). Follow-up serum sodium data were available in 68 patients. At hospital discharge, 45 of 68 (66.2%) hyponatremic patients had improvements in serum sodium levels (> or = 2 mmol/l). Hyponatremic patients with a serum sodium improvement had a mortality rate of 11.1% at 60 days post discharge, compared with a 21.7% mortality rate in those showing no improvement. After covariate adjustment, change in serum sodium was a statistically significant predictor of 60-day mortality (HR: 0.736, 95% CI: 0.569-0.952 for each 1-mmol/l increase in serum sodium from baseline).

CONCLUSIONS

Serum sodium improvements during hospitalization for heart failure were associated with improved survival at 60 days.

Authors+Show Affiliations

Feinberg School of Medicine Northwestern University, Chicago, Illinois 60611, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial, Phase II
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17573581

Citation

Rossi, Joseph, et al. "Improvement in Hyponatremia During Hospitalization for Worsening Heart Failure Is Associated With Improved Outcomes: Insights From the Acute and Chronic Therapeutic Impact of a Vasopressin Antagonist in Chronic Heart Failure (ACTIV in CHF) Trial." Acute Cardiac Care, vol. 9, no. 2, 2007, pp. 82-6.
Rossi J, Bayram M, Udelson JE, et al. Improvement in hyponatremia during hospitalization for worsening heart failure is associated with improved outcomes: insights from the Acute and Chronic Therapeutic Impact of a Vasopressin Antagonist in Chronic Heart Failure (ACTIV in CHF) trial. Acute Card Care. 2007;9(2):82-6.
Rossi, J., Bayram, M., Udelson, J. E., Lloyd-Jones, D., Adams, K. F., Oconnor, C. M., Stough, W. G., Ouyang, J., Shin, D. D., Orlandi, C., & Gheorghiade, M. (2007). Improvement in hyponatremia during hospitalization for worsening heart failure is associated with improved outcomes: insights from the Acute and Chronic Therapeutic Impact of a Vasopressin Antagonist in Chronic Heart Failure (ACTIV in CHF) trial. Acute Cardiac Care, 9(2), 82-6.
Rossi J, et al. Improvement in Hyponatremia During Hospitalization for Worsening Heart Failure Is Associated With Improved Outcomes: Insights From the Acute and Chronic Therapeutic Impact of a Vasopressin Antagonist in Chronic Heart Failure (ACTIV in CHF) Trial. Acute Card Care. 2007;9(2):82-6. PubMed PMID: 17573581.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Improvement in hyponatremia during hospitalization for worsening heart failure is associated with improved outcomes: insights from the Acute and Chronic Therapeutic Impact of a Vasopressin Antagonist in Chronic Heart Failure (ACTIV in CHF) trial. AU - Rossi,Joseph, AU - Bayram,Melike, AU - Udelson,James E, AU - Lloyd-Jones,Donald, AU - Adams,Kirkwood F, AU - Oconnor,Christopher M, AU - Stough,Wendy Gattis, AU - Ouyang,John, AU - Shin,David D, AU - Orlandi,Cesare, AU - Gheorghiade,Mihai, PY - 2007/6/19/pubmed PY - 2007/10/6/medline PY - 2007/6/19/entrez SP - 82 EP - 6 JF - Acute cardiac care JO - Acute Card Care VL - 9 IS - 2 N2 - BACKGROUND: Hyponatremia predicts poor outcome in patients with acute heart failure syndromes. This study evaluated the relationship between baseline serum sodium, change in serum sodium, and 60-day mortality in hospitalized heart failure patients. METHODS: A post-hoc analysis of the ACTIV in CHF trial was performed. ACTIV in CHF randomized 319 patients hospitalized for worsening heart failure to placebo or one of three tolvaptan doses. Cox proportional hazards regression-analysis was used to explore the relationship between baseline hyponatremia, sodium change during the hospitalization, and 60-day mortality. RESULTS: Hyponatremia was observed in 69 patients (21.6%). After covariate adjustment, baseline hyponatremia was a statistically significant predictor of 60-day mortality (P = 0.0016). Follow-up serum sodium data were available in 68 patients. At hospital discharge, 45 of 68 (66.2%) hyponatremic patients had improvements in serum sodium levels (> or = 2 mmol/l). Hyponatremic patients with a serum sodium improvement had a mortality rate of 11.1% at 60 days post discharge, compared with a 21.7% mortality rate in those showing no improvement. After covariate adjustment, change in serum sodium was a statistically significant predictor of 60-day mortality (HR: 0.736, 95% CI: 0.569-0.952 for each 1-mmol/l increase in serum sodium from baseline). CONCLUSIONS: Serum sodium improvements during hospitalization for heart failure were associated with improved survival at 60 days. SN - 1748-2941 UR - https://www.unboundmedicine.com/medline/citation/17573581/Improvement_in_hyponatremia_during_hospitalization_for_worsening_heart_failure_is_associated_with_improved_outcomes:_insights_from_the_Acute_and_Chronic_Therapeutic_Impact_of_a_Vasopressin_Antagonist_in_Chronic_Heart_Failure__ACTIV_in_CHF__trial_ L2 - https://www.tandfonline.com/doi/full/10.1080/17482940701210179 DB - PRIME DP - Unbound Medicine ER -