Key result
Hyponatremia at admission in hospitalized Asian heart failure patients was associated with a significantly higher 12-month mortality rate (27.9% vs. 14.6%) and a 72% increased risk of death (HR 1.72).
Why the study?
Does admission hyponatremia predict 12-month mortality in hospitalized Asian patients with systolic heart failure?
Cohort (n=1,470)
Yes
Does admission hyponatremia predict 12-month mortality in hospitalized Asian patients with systolic heart failure?
Hazard Ratio: 1.72 (95% CI 1.12–2.65)
Absolute Event Rate: 27.9% vs 14.6%
p-value: p=<0.001
In hospitalized Asian patients with systolic heart failure, admission hyponatremia is a common and independent predictor of 12-month mortality and is associated with underuse of optimal medical therapy.
Supports admission sodium for prognostication in Asian HF inpatients; leaves open whether correction improves survival in prospective trials.
BACKGROUND/AIMS: Hyponatremia is a well-known risk factor for poor outcomes in Western studies of heart failure (HF) patients. We evaluated the predictive value of hyponatremia in hospitalized Asian HF patients. METHODS: The Clinical Characteristics and Outcomes in the Relation with Serum Sodium Level in Asian Patients Hospitalized for Heart Failure (the COAST) study enrolled hospitalized patients with systolic HF (ejection fraction < 45%) at eight centers in South Korea, Taiwan, and China. The relationship between admission sodium level and clinical outcomes was analyzed in 1,470 patients. RESULTS: The mean admission sodium level was 138 ± 4.7 mmol/L, and 247 patients (16.8%) had hyponatremia defined as Na(+) < 135 mmol/L. The 12-month mortality was higher in hyponatremic patients (27.9% vs. 14.6%, p < 0.001), and hyponatremia was an independent predictor of 12-month mortality (hazard ratio, 1.72; 95% confidence interval, 1.12 to 2.65). During hospital admission, 57% of hyponatremic patients showed improvement without improvement in their clinical outcomes (p = 0.620). The proportion of patients with optimal medical treatment was only 26.5% and 44.2% at admission and discharge, respectively, defined as the combined use of angiotensin-converting-enzyme inhibitor/angiotensin receptor blocker and β-blocker. Underuse of optimal medical treatment was more pronounced in hyponatremic patients. CONCLUSIONS: In hospitalized Asian HF patients, hyponatremia at admission is common and is an independent predictor of poor clinical outcome. Furthermore, hyponatremic patients receive less optimal medical treatment than their counterparts.
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Yoo et al. (2015) conducted a cohort in Hospitalized systolic heart failure (n=1,470). Hyponatremia (Na+ < 135 mmol/L) vs. Normonatremia (Na+ ≥ 135 mmol/L) was evaluated on 12-month mortality from the index hospitalization (HR 1.72, 95% CI 1.12-2.65, p=<0.001). Hyponatremia at admission in hospitalized Asian heart failure patients was associated with a significantly higher 12-month mortality rate (27.9% vs. 14.6%) and a 72% increased risk of death (HR 1.72).
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