TY - JOUR T1 - Impact of Dietary Sodium Restriction on Heart Failure Outcomes. AU - Doukky,Rami, AU - Avery,Elizabeth, AU - Mangla,Ashvarya, AU - Collado,Fareed M, AU - Ibrahim,Zeina, AU - Poulin,Marie-France, AU - Richardson,DeJuran, AU - Powell,Lynda H, PY - 2015/07/14/received PY - 2015/08/06/accepted PY - 2016/1/8/entrez PY - 2016/1/8/pubmed PY - 2016/10/12/medline KW - Heart Failure Adherence and Retention Trial KW - heart failure KW - outcome KW - salt restriction KW - sodium restriction SP - 24 EP - 35 JF - JACC. Heart failure JO - JACC Heart Fail VL - 4 IS - 1 N2 - OBJECTIVES: This study sought to evaluate the impact of sodium restriction on heart failure (HF) outcomes. BACKGROUND: Although sodium restriction is advised for patients with HF, data on sodium restriction and HF outcomes are inconsistent. METHODS: We analyzed data from the multihospital HF Adherence and Retention Trial, which enrolled 902 New York Heart Association functional class II/III HF patients and followed them up for a median of 36 months. Sodium intake was serially assessed by a food frequency questionnaire. Based on the mean daily sodium intake prior to the first event of death or HF hospitalization, patients were classified into sodium restricted (<2,500 mg/d) and unrestricted (≥2,500 mg/d) groups. Study groups were propensity score matched according to plausible baseline confounders. The primary outcome was a composite of death or HF hospitalization. The secondary outcomes were cardiac death and HF hospitalization. RESULTS: Sodium intake data were available for 833 subjects (145 sodium restricted, 688 sodium unrestricted), of whom 260 were propensity matched into sodium restricted (n = 130) and sodium unrestricted (n = 130) groups. Sodium restriction was associated with significantly higher risk of death or HF hospitalization (42.3% vs. 26.2%; hazard ratio [HR]: 1.85; 95% confidence interval [CI]: 1.21 to 2.84; p = 0.004), derived from an increase in the rate of HF hospitalization (32.3% vs. 20.0%; HR: 1.82; 95% CI: 1.11 to 2.96; p = 0.015) and a nonsignificant increase in the rate of cardiac death (HR: 1.62; 95% CI: 0.70 to 3.73; p = 0.257) and all-cause mortality (p = 0.074). Exploratory subgroup analyses suggested that sodium restriction was associated with increased risk of death or HF hospitalization in patients not receiving angiotensin-converting enzyme inhibitor or angiotensin receptor blocker (HR: 5.78; 95% CI: 1.93 to 17.27; p = 0.002). CONCLUSIONS: In symptomatic patients with chronic HF, sodium restriction may have a detrimental impact on outcome. A randomized clinical trial is needed to definitively address the role of sodium restriction in HF management. (A Self-management Intervention for Mild to Moderate Heart Failure [HART]; NCT00018005). SN - 2213-1787 UR - https://www.unboundmedicine.com/medline/citation/26738949/Impact_of_Dietary_Sodium_Restriction_on_Heart_Failure_Outcomes_ DB - PRIME DP - Unbound Medicine ER -