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Dietary sodium restriction does not prevent adverse events in ambulatory adults with heart failure (SODIUM-HF)
Clinical Question
Does restricting dietary sodium improve outcomes in outpatients with heart failure?
Bottom line
In this underpowered study, a low-sodium diet in optimally treated ambulatory adults with NYHA class 2 or 3 heart failure was no more effective at decreasing clinical outcomes than general guidance to restrict sodium intake. 1b-
Reference
Study design: Randomized controlled trial (nonblinded)
Funding: Government
Setting: Outpatient (specialty)
Synopsis
In this pragmatic multinational study, adults with optimally treated New York Heart Association (NYHA) class 2 or 3 heart failure were randomized to a low-sodium diet (< 100 mmol or 1500 mg daily; n = 397) or usual care (given generic advice about dietary sodium restriction; n = 409). For both groups of participants, the researchers assessed dietary sodium intake at baseline and then at 6 months and 12 months. They also evaluated the intervention group at 3 months and 9 months. The baseline characteristics of each group were comparable, although no data on race or socioeconomic status were collected. Not surprising, over the 12 months of follow-up, the dietary intake of sodium decreased significantly more in the intervention group than in the control group. The authors used to intention-to-treat analysis for the composite outcome of hospitalizations or emergency department visits for cardiovascular events and all-cause death, which occurred at a similar rate between the groups (15% of the intervention group and 17% of the control group). The authors make the global statement that no safety events attributable to the study occurred in either group. Here's the bad news: The study was terminated early for multiple reasons, including operational feasibility and COVID-19. As a result, the authors were unable to enroll enough persons to meet their goal of 992, which would have been adequate to detect at least a 30% reduction in the composite outcome.
Reviewer
Henry C. Barry, MD, MS
Professor
Michigan State University
East Lansing, MI
Comments
Poor study
Not worth reporting. Better evaluation on other studies shows that there is real value to reducing Na below 3 gm but not that low as very few patients will comply
Low sodium diet modifying the out come of cardiac failure ma
Though the aim of the study is highly reasonable ,the sample size and duration study could not conform the required limits. But anyhow the impact of low sodium diet on management of cardiac failure appeared palpable and was in accordance with the common belief amongst practicing phycisians and cardiologists.
Needless to say high blood sodium levels do promote water retention both in ECF and cellular levels and consequent increase in left ventricular end diastolic volume and the resultant pump failure. Study is well contributing ,more so to the acumen of general practitioners.
N/A
N/A
sodium intake and CHF
dietary restriction does not help with CHF restrictions