title: Impact of Dietary Sodium Restriction on Heart Failure Outcomes.
abstract: OBJECTIVE
  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).
authors.affiliation: Department of Preventive Medicine, Rush University Medical Center, Chicago, Illinois; Division of Cardiology, John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois; Division of Cardiology, Rush University Medical Center, Chicago, Illinois; Rush Center for Urban Health Equity, Rush University Medical Center, Chicago, Illinois. Electronic address: rami_doukky@rush.edu.
authors.forename: Rami
authors.initials: R
authors.lastname: Doukky
authors.affiliation: Department of Preventive Medicine, Rush University Medical Center, Chicago, Illinois; Rush Center for Urban Health Equity, Rush University Medical Center, Chicago, Illinois.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Avery
authors.affiliation: Department of Preventive Medicine, Rush University Medical Center, Chicago, Illinois; Division of Cardiology, Rush University Medical Center, Chicago, Illinois; Rush Center for Urban Health Equity, Rush University Medical Center, Chicago, Illinois.
authors.forename: Ashvarya
authors.initials: A
authors.lastname: Mangla
authors.affiliation: Division of Cardiology, Rush University Medical Center, Chicago, Illinois.
authors.forename: Fareed M
authors.initials: FM
authors.lastname: Collado
authors.affiliation: Division of Cardiology, John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois.
authors.forename: Zeina
authors.initials: Z
authors.lastname: Ibrahim
authors.affiliation: Division of Cardiology, Rush University Medical Center, Chicago, Illinois.
authors.forename: Marie-France
authors.initials: MF
authors.lastname: Poulin
authors.affiliation: Department of Preventive Medicine, Rush University Medical Center, Chicago, Illinois; Rush Center for Urban Health Equity, Rush University Medical Center, Chicago, Illinois; Department of Mathematics and Computer Science, Lake Forest College, Lake Forest, Illinois.
authors.forename: DeJuran
authors.initials: D
authors.lastname: Richardson
authors.affiliation: Department of Preventive Medicine, Rush University Medical Center, Chicago, Illinois; Rush Center for Urban Health Equity, Rush University Medical Center, Chicago, Illinois.
authors.forename: Lynda H
authors.initials: LH
authors.lastname: Powell
mesh_terms: D002908:Chronic Disease; D004039:Diet, Sodium-Restricted / Q000401:mortality*; D005260:Female; D006333:Heart Failure / Q000178:diet therapy* / Q000401:mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D016896:Treatment Outcome
keywords: Heart Failure Adherence and Retention Trial; heart failure; outcome; salt restriction; sodium restriction