title: Dietary sodium restriction below 2 g per day predicted shorter event-free survival in patients with mild heart failure.
abstract: BACKGROUND
  Despite a growing recognition that a strict low sodium diet may not be warranted in compensated heart failure (HF) patients, the link between sodium restriction below 2 g/day and health outcomes is unknown in patients at different levels of HF severity.
  
  
  OBJECTIVE
  The purpose of this study was to compare differences in event-free survival among patients with <2 g/day, 2-3 g/day, or >3 g/day sodium intake stratified by New York Heart Association (NYHA) class.
  
  
  METHODS
  A total of 244 patients with HF completed a four-day food diary to measure daily sodium intake. All-cause hospitalization or death for a median of 365 follow-up days and covariates on age, gender, etiology, body mass index, NYHA class, ejection fraction, total comorbidity score, the presence of ankle edema, and prescribed medications were determined by patient interview and medical record review. Hierarchical Cox hazard regression was used to address the purpose.
  
  
  RESULTS
  In NYHA class I/II (n=134), patients with <2 g/day sodium intake had a 3.7-times higher risk (p=0.025), while patients with >3 g/day sodium intake had a 0.4-times lower risk (p=0.047) for hospitalization or death than those with 2-3 g/day sodium intake after controlling for covariates. In NYHA class III/IV (n=110), >3 g/day sodium intake predicted shorter event-free survival (p=0.044), whereas there was no difference in survival curves between patients with <2 g/day and those with 2-3 g/day sodium intake.
  
  
  CONCLUSIONS
  Sodium restriction below 2 g/day is not warranted in mild HF patients, whereas excessive sodium intake above 3 g/day may be harmful in moderate to severe HF patients.
authors.affiliation: Department of Nursing, College of Medicine, University of Ulsan, Republic of Korea gracesong@ulsan.ac.kr.
authors.forename: Eun Kyeung
authors.initials: EK
authors.lastname: Song
authors.affiliation: College of Nursing, University of Kentucky, USA.
authors.forename: Debra K
authors.initials: DK
authors.lastname: Moser
authors.affiliation: Nell Hodgson Woodruff School of Nursing, Emory University, USA.
authors.forename: Sandra B
authors.initials: SB
authors.lastname: Dunbar
authors.affiliation: University of Michigan, School of Nursing, USA.
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Pressler
authors.affiliation: College of Nursing, University of Kentucky, USA.
authors.forename: Terry A
authors.initials: TA
authors.lastname: Lennie
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D015331:Cohort Studies; D016001:Confidence Intervals; D015930:Diet Records; D004039:Diet, Sodium-Restricted / Q000009:adverse effects*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis / Q000378:metabolism* / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012982:Sodium, Dietary / Q000008:administration & dosage*; D062606:Tertiary Care Centers; D013997:Time Factors; D014481:United States
chemical_list: D012982:Sodium, Dietary
keywords: Sodium-restricted diet; health outcomes; heart failure