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Limited evidence to support the benefit of sodium restriction for heart failure
Clinical Question
Is sodium restriction useful for patients with heart failure?
Bottom line
Everyone can recall a patient with heart failure after a meal of sodium-laden soup or snack food. Sodium restriction, a cornerstone of heart failure management for years, is based on good evidence, right? Turns out there is very little evidence for this, and most of it shows no benefit. What to do? On the one hand, some patients may find they have fewer symptoms with sodium restriction. However, one argument against prolonged sodium restriction is that it leaves patients unprepared when they suddenly overdo it, thereby causing harm. Both ideas are speculations drawn from physiology-based reasoning. After all these years we need good research to determine what to do. 1a
Reference
Study design: Meta-analysis (randomized controlled trials)
Funding: Government
Setting: Various (meta-analysis)
Synopsis
To identify randomized controlled trials, the researchers searched 4 databases, including Cochrane CENTRAL, and found just 9 studies with a total of 479 patients that evaluated sodium restriction in patients with heart failure. The authors conducted the study using the Cochrane method of extracting and analyzing the data. No studies were large enough or long enough to evaluate the effect of sodium restriction on mortality. Two studies (n = 107 patients) found no difference in hospital length of stay or hospital readmissions following sodium restriction during admission. Four of the six outpatient studies found no difference in symptoms with sodium restriction as compared with standard intake. The studies are too few and too small to find differences in outcomes if any exist and the study designs of the included studies are variable.
Reviewer
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA
Comments
good to know
Moderation in every thing is always good