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Title: | Hyponatraemia and changes in natraemia during hospitalization for acute heart failure and associations with in-hospital and long-term outcomes - from the ESC-HFA EORP Heart Failure Long-Term Registry | Authors: | Kaplon-Cieslicka, Agnieszka Benson, Lina Chioncel, Ovidiu G. Crespo-Leiro, Maria Coats, Andrew J. S. D. Anker, Stefan Ruschitzka, Frank Hage, Camilla Drozdz, Jaroslaw Seferovic, Petar Rosano, Giuseppe M. C. Piepoli, Massimo Mebazaa, Alexandre McDonagh, Theresa Lainscak, Mitja Savarese, Gianluigi Ferrari, Roberto MULLENS, Wilfried Bayes-Genis, Antoni P. Maggioni, Aldo H. Lund, Lars |
Issue Date: | 2023 | Publisher: | WILEY | Source: | EUROPEAN JOURNAL OF HEART FAILURE, 25 (9), p. 1571-1583 | Abstract: | Aims To comprehensively assess hyponatraemia in acute heart failure (AHF) regarding prevalence, associations, hospital course, and post-discharge outcomes. Methods and results Of 8298 patients in the European Society of Cardiology Heart Failure Long-Term Registry hospitalized for AHF with any ejection fraction, 20% presented with hyponatraemia (serum sodium <135 mmol/L). Independent predictors included lower systolic blood pressure, estimated glomerular filtration rate (eGFR) and haemoglobin, along with diabetes, hepatic disease, use of thiazide diuretics, mineralocorticoid receptor antagonists, digoxin, higher doses of loop diuretics, and non-use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and beta-blockers. In-hospital death occurred in 3.3%. The prevalence of hyponatraemia and in-hospital mortality with different combinations were: 9% hyponatraemia both at admission and discharge (hyponatraemia Yes/Yes, in-hospital mortality 6.9%), 11% Yes/No (in-hospital mortality 4.9%), 8% No/Yes (in-hospital mortality 4.7%), and 72% No/No (in-hospital mortality 2.4%). Correction of hyponatraemia was associated with improvement in eGFR. In-hospital development of hyponatraemia was associated with greater diuretic use and worsening eGFR but also more effective decongestion. Among hospital survivors, 12-month mortality was 19% and adjusted hazard ratios (95% confidence intervals) were for hyponatraemia Yes/Yes 1.60 (1.35- 1.89), Yes/No 1.35 (1.14-1.59), and No/Yes 1.18 (0.96-1.45). For death or heart failure hospitalization they were 1.38 (1.21- 1.58), 1.17 (1.02- 1.33), and 1.09 (0.93-1.27), respectively. Conclusion Among patients with AHF, 20% had hyponatraemia at admission, which was associated with more advanced heart failure and normalized in half of patients during hospitalization. Admission hyponatraemia (possibly dilutional), especially if it did not resolve, was associated with worse in-hospital and post-discharge outcomes. Hyponatraemia developing during hospitalization (possibly depletional) was associated with lower risk. | Notes: | Lund, LH (corresponding author), Karolinska Inst, Dept Med, Eugeniavagen 3,Norrbacka,S1 02, Stockholm 17176, Sweden.; Lund, LH (corresponding author), Karolinska Univ Hosp, Dept Cardiol, Eugeniavagen 3,Norrbacka,S1 02, S-17176 Stockholm, Sweden. lars.lund@alumni.duke.edu |
Keywords: | Acute heart failure;Worsening heart failure;Hyponatraemia;Sodium;Prognosis;Congestion | Document URI: | http://hdl.handle.net/1942/40445 | ISSN: | 1388-9842 | e-ISSN: | 1879-0844 | DOI: | 10.1002/ejhf.2873 | ISI #: | 000993762100001 | Rights: | 2023 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. | Category: | A1 | Type: | Journal Contribution |
Appears in Collections: | Research publications |
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