Key result
Severe sodium restriction fails to reduce HF mortality and hospitalization despite slight QoL improvements.
Why the study?
Despite long-standing recommendations for sodium reduction in heart failure, large randomized trials were lacking and some studies suggested worse outcomes with strict restriction.
Does strict sodium restriction reduce mortality and hospitalization in patients with heart failure?
Does strict sodium restriction reduce mortality and hospitalization in patients with heart failure?
Strict sodium restriction does not reduce mortality or hospitalization in heart failure patients, but may offer slight symptomatic improvement.
Challenges longstanding sodium restriction guidance in HF; leaves open optimal targets pending definitive RCTs.
BACKGROUND: For decades standard teaching recommended salt intake (sodium) reduction in patients suffering from heart failure. Neurohumoral activation with subsequent fluid retention provided a solid rationale for this long-standing recommendation. Until recently no large randomized clinical trial of sodium restriction was available, while some observational studies and metanalyses even suggested a worse outcome with strict sodium restriction in patients with heart failure. METHODS: In this narrative review we aimed to extricate from the literature whether strict sodium restriction is beneficial in patients with heart failure. We searched PubMed indexed articles between 2000 and 2023 for these terms: heart failure, salt, sodium, fluid intake. RESULTS: Most randomized trials were small and showed a wide heterogeneity of interventions. A single large, randomized clinical trial was stopped early due to futility. Overall, there is no evidence that severe sodium restriction reduces the incidence of mortality and hospitalization in patients with heart failure. Quality of life and functional class may improve slightly with sodium restriction. CONCLUSION: Morbidity and mortality are not reduced with sodium restriction in patients with heart failure, although some symptomatic improvement may be expected.
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Paolo Raggi (2024) conducted a review in heart failure. Sodium restriction vs. No sodium restriction was evaluated on mortality and hospitalization. Severe sodium restriction does not reduce mortality and hospitalization in patients with heart failure, although it may slightly improve quality of life and functional class.
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