title: Improvement of hyponatraemia during hospitalisation for acute heart failure is not associated with improvement of prognosis: an analysis from the Korean Heart Failure (KorHF) registry.
abstract: OBJECTIVE
  Hyponatraemia predicts poor prognosis in patients hospitalised for acute heart failure (AHF). Yet, the association of hyponatraemia improvement with better postdischarge outcome has not been elucidated. Here, we determined the clinical impact of hyponatraemia improvement during hospitalisation on postdischarge outcome in patients admitted for AHF.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Nation-wide twenty-four academic hospitals in Korea (mean follow-up of 1.7 years after discharge).
  
  
  METHODS
  2888 patients hospitalised for AHF.
  
  
  METHODS
  Primary endpoints were composite of death or rehospitalisation due to heart failure.
  
  
  RESULTS
  Hyponatraemia was present in 575 of total 2888 patients hospitalised for AHF at admission. Hyponatraemia was normalised in 274 patients (47.7%) at discharge. During mean follow-up of 1.7 years total 735 rehospitalisations and 397 deaths were documented. Persistent hyponatraemia during hospitalisation was significantly associated with increased incidence of composite endpoint of death or rehospitalisation in multivariate analysis compared with normonatraemia at admission (HR 1.345, 95% CI 1.075 to 1.683, p=0.010). However, improvement of hyponatraemia during hospitalisation was not significantly associated with lower incidence of composite endpoint of death or rehospitalisation in multivariate analysis (HR 1.084, 95% CI 0.709 to 1.659, p=0.709). Improved hyponatraemia was not associated with better prognosis in analysis with propensity score matching, either (HR 1.111, 95% CI 0.588 to 2.100, p=0.746).
  
  
  CONCLUSIONS
  In patients hospitalised for AHF, hyponatraemia on admission is associated with a worse prognosis compared with normonatraemia, irrespective of whether hyponatraemia improves during hospitalisation.
authors.affiliation: Department of Internal Medicine, Seoul National University Bundang Hospital, College of Medicine, Seoul National University, Bundang, Seongnam, Gyeonggi-do, Republic of Korea.
authors.forename: Sang Eun
authors.initials: SE
authors.lastname: Lee
authors.forename: Dong-Ju
authors.initials: DJ
authors.lastname: Choi
authors.forename: Chang-Hwan
authors.initials: CH
authors.lastname: Yoon
authors.forename: Il-Young
authors.initials: IY
authors.lastname: Oh
authors.forename: Eun-Seok
authors.initials: ES
authors.lastname: Jeon
authors.forename: Jae-Joong
authors.initials: JJ
authors.lastname: Kim
authors.forename: Myeong-Chan
authors.initials: MC
authors.lastname: Cho
authors.forename: Shung Chull
authors.initials: SC
authors.lastname: Chae
authors.forename: Kyu-Hyung
authors.initials: KH
authors.lastname: Ryu
authors.forename: Byung-Hee
authors.initials: BH
authors.lastname: Oh
mesh_terms: D000368:Aged; D019468:Disease Management; D018450:Disease Progression; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000150:complications* / Q000401:mortality; D006760:Hospitalization; D006801:Humans; D007010:Hyponatremia / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D015994:Incidence; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D056910:Republic of Korea / Q000453:epidemiology; D012964:Sodium / Q000097:blood*; D015996:Survival Rate / Q000639:trends
chemical_list: D012964:Sodium