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Hyponatremia and long-term outcomes in chronic heart failure--an observational study from the Duke Databank for
Luca Bettari1, Mona Fiuzat, Linda K Shaw
1Section of Cardiovascular Diseases, Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy. luca_bettari@yahoo.it
Insights
Hyponatremia, or low sodium levels, is common in heart failure (HF) patients with systolic dysfunction. This condition independently predicts a higher risk of death and cardiovascular events, impacting long-term survival.
Area of Science:
- Cardiology
- Internal Medicine
- Clinical Research
Background:
- Hyponatremia is a known short-term outcome predictor in heart failure (HF).
- Its long-term prognostic value in HF patients with systolic dysfunction remains unclear.
Purpose of the Study:
- To investigate hyponatremia as an independent predictor of long-term mortality and cardiovascular events in HF patients with systolic dysfunction.
Main Methods:
- A cohort of 1,045 HF patients with systolic dysfunction was identified from the Duke Databank for Cardiovascular Diseases.
- Multivariable Cox proportional regression models were used to assess the association between hyponatremia and outcomes.
Main Results:
- Hyponatremia was present in 10.2% of patients and associated with older age, anemia, and more severe HF.
- Unadjusted analysis showed hyponatremia increased risk of all-cause death (HR 1.89) and CV death/rehospitalization (HR 1.40).
- Multivariable analysis confirmed hyponatremia as an independent predictor for all-cause death (HR 1.42) and CV death/rehospitalization (HR 1.45).
Conclusions:
- Hyponatremia is prevalent in HF patients with left ventricular (LV) dysfunction.
- Low sodium levels are independently linked to increased all-cause mortality and cardiovascular mortality/rehospitalization.
Background:
Hyponatremia is a well known predictor of short-term outcomes in heart failure (HF); however, its impact on long-term survival in HF patients with systolic dysfunction is not well established.
Methods And Results:
Using the Duke Databank for Cardiovascular Diseases, we identified 1,045 patients with HF and systolic dysfunction undergoing cardiac catheterization from January 2000 through December 2008. The effect of hyponatremia as independent predictor of all-cause death and cardiovascular death/rehospitalization was examined using a multivariable Cox proportional regression model. Hyponatremia was present in 107/1,045 patients (10.2%). Hyponatremic patients were older, more likely to be anemic, with higher heart rate and levels of blood urea nitrogen, lower blood pressure, and more severe HF. Using an unadjusted analysis, hyponatremia was associated with higher risk of all-cause death (hazard ratio [HR] 1.89, 95% confidence interval [CI] 1.44-2.49; P < .0001) and of cardiovascular death/rehospitalization (HR 1.40, 95% CI 1.11-1.77; P = .005) at 4.5 years. When entered into a multivariable Cox model, hyponatremia remained significant for all-cause death (HR 1.42, 95% CI 1.07-1.88) and for cardiovascular death/rehospitalization (HR 1.45, 95% CI 1.14-1.86).
Conclusions:
Hyponatremia is relatively common in HF patients with LV dysfunction and is independently associated with increased risk of all-cause mortality and cardiovascular mortality/rehospitalization.
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