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Relation of serum sodium level to long-term outcome after a first hospitalization for heart failure with preserved ejection fraction.
Am J Cardiol. 2009 Feb 01; 103(3):405-10.AJ

Abstract

Hyponatremia is a predictor of adverse short-term outcomes in patients with acute heart failure (HF). The impact of hyponatremia on long-term survival in patients with HF with preserved ejection fraction (HFPEF) has not been evaluated. Our aim was to prospectively assess the impact of baseline natremia and changes in sodium level during hospitalization on 7-year outcome in 358 patients surviving a first hospitalization for HFPEF. On admission, hyponatremia (sodium <136 mEq/L) was diagnosed in 91 patients (25.4%). Baseline hyponatremia was associated with an increased risk of overall (hazard ratio [HR] 1.98, 95% confidence interval [CI] 1.50 to 2.61) and cardiovascular mortality (HR 1.92, 95% CI 1.36 to 2.73). After adjustment for covariates, the relations remained significant. Seven-year relative survival (observed/expected survival) of hyponatremic patients was lower than that of patients with normal baseline natremia (31% vs 63%). The association of sodium and risk of death appeared linear across quartiles of baseline natremia and slightly stronger at the lowest of sodium values. At discharge, 45 patients with low baseline sodium had normal natremia (49%) and 46 had persistent hyponatremia (51%). Patients with normalized natremia at discharge had excess 7-year overall mortality compared with the normonatremic group (HR 1.50, 95% CI 1.03 to 2.19). Patients with persistent hyponatremia had the lowest 7-year survival (HR 2.67, 95% CI 1.89 to 3.78). After adjustment for covariates, patients with persistent hyponatremia had an impressive increase in relative risk of overall mortality compared with patients with normal baseline natremia. In conclusion, hyponatremia is a powerful predictor of long-term mortality in patients with HFPEF. Patients with HFPEF and persistent hyponatremia are at high risk of adverse outcomes.

Authors+Show Affiliations

INSERM, ERI 12, and University Hospital Amiens, Amiens, France.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19166698

Citation

Rusinaru, Dan, et al. "Relation of Serum Sodium Level to Long-term Outcome After a First Hospitalization for Heart Failure With Preserved Ejection Fraction." The American Journal of Cardiology, vol. 103, no. 3, 2009, pp. 405-10.
Rusinaru D, Buiciuc O, Leborgne L, et al. Relation of serum sodium level to long-term outcome after a first hospitalization for heart failure with preserved ejection fraction. Am J Cardiol. 2009;103(3):405-10.
Rusinaru, D., Buiciuc, O., Leborgne, L., Slama, M., Massy, Z., & Tribouilloy, C. (2009). Relation of serum sodium level to long-term outcome after a first hospitalization for heart failure with preserved ejection fraction. The American Journal of Cardiology, 103(3), 405-10. https://doi.org/10.1016/j.amjcard.2008.09.091
Rusinaru D, et al. Relation of Serum Sodium Level to Long-term Outcome After a First Hospitalization for Heart Failure With Preserved Ejection Fraction. Am J Cardiol. 2009 Feb 1;103(3):405-10. PubMed PMID: 19166698.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Relation of serum sodium level to long-term outcome after a first hospitalization for heart failure with preserved ejection fraction. AU - Rusinaru,Dan, AU - Buiciuc,Otilia, AU - Leborgne,Laurent, AU - Slama,Michel, AU - Massy,Ziad, AU - Tribouilloy,Christophe, Y1 - 2008/11/19/ PY - 2008/08/12/received PY - 2008/09/16/revised PY - 2008/09/16/accepted PY - 2009/1/27/entrez PY - 2009/1/27/pubmed PY - 2009/2/12/medline SP - 405 EP - 10 JF - The American journal of cardiology JO - Am J Cardiol VL - 103 IS - 3 N2 - Hyponatremia is a predictor of adverse short-term outcomes in patients with acute heart failure (HF). The impact of hyponatremia on long-term survival in patients with HF with preserved ejection fraction (HFPEF) has not been evaluated. Our aim was to prospectively assess the impact of baseline natremia and changes in sodium level during hospitalization on 7-year outcome in 358 patients surviving a first hospitalization for HFPEF. On admission, hyponatremia (sodium <136 mEq/L) was diagnosed in 91 patients (25.4%). Baseline hyponatremia was associated with an increased risk of overall (hazard ratio [HR] 1.98, 95% confidence interval [CI] 1.50 to 2.61) and cardiovascular mortality (HR 1.92, 95% CI 1.36 to 2.73). After adjustment for covariates, the relations remained significant. Seven-year relative survival (observed/expected survival) of hyponatremic patients was lower than that of patients with normal baseline natremia (31% vs 63%). The association of sodium and risk of death appeared linear across quartiles of baseline natremia and slightly stronger at the lowest of sodium values. At discharge, 45 patients with low baseline sodium had normal natremia (49%) and 46 had persistent hyponatremia (51%). Patients with normalized natremia at discharge had excess 7-year overall mortality compared with the normonatremic group (HR 1.50, 95% CI 1.03 to 2.19). Patients with persistent hyponatremia had the lowest 7-year survival (HR 2.67, 95% CI 1.89 to 3.78). After adjustment for covariates, patients with persistent hyponatremia had an impressive increase in relative risk of overall mortality compared with patients with normal baseline natremia. In conclusion, hyponatremia is a powerful predictor of long-term mortality in patients with HFPEF. Patients with HFPEF and persistent hyponatremia are at high risk of adverse outcomes. SN - 1879-1913 UR - https://www.unboundmedicine.com/medline/citation/19166698/Relation_of_serum_sodium_level_to_long_term_outcome_after_a_first_hospitalization_for_heart_failure_with_preserved_ejection_fraction_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-9149(08)01708-6 DB - PRIME DP - Unbound Medicine ER -