Jin Joo Park1, Young-Jin Cho1, Il-Young Oh1, Hyun-Ah Park2, Hae-Young Lee3, Kye Hun Kim4, Byung-Su Yoo5, Seok-Min Kang6, Sang Hong Baek7, Eun-Seok Jeon8, Jae-Joong Kim9, Myeong-Chan Cho10, Shung Chull Chae11, Byung-Hee Oh3, Dong-Ju Choi12. 1. Seoul National University Bundang Hospital, Seongnam, Republic of Korea. 2. Department of Family Medicine, Inje University Seoul Paik Hospital, Seoul, Republic of Korea. 3. Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea. 4. Heart Research Center of Chonnam National University, Gwangju, Republic of Korea. 5. Yonsei University Wonju College of Medicine, Wonju, Republic of Korea. 6. Yonsei University College of Medicine, Seoul, Republic of Korea. 7. The Catholic University of Korea, Seoul, Republic of Korea. 8. Sungkyunkwan University College of Medicine, Seoul, Republic of Korea. 9. University of Ulsan College of Medicine, Seoul, Republic of Korea. 10. Chungbuk National University College of Medicine, Cheongju, Republic of Korea. 11. Kyungpook National University College of Medicine, Daegu, Republic of Korea. 12. Seoul National University Bundang Hospital, Seongnam, Republic of Korea. Electronic address: djchoi@snubh.org.
Abstract
BACKGROUND: Hyponatremia is a well-known risk factor for worse outcomes in heart failure (HF) patients. The impact of hyponatremia according to the ejection fraction (EF) is unclear. We evaluated the prognostic value of hyponatremia according to HF type. METHODS AND RESULTS: The Korea Acute Heart Failure (KorAHF) registry consecutively enrolled 5625 patients. Hyponatremia was defined as serum sodium level<135mmol/L at hospital admission. HF with preserved and reduced ejection fraction were defined as an LVEF ≥50% and LVEF ≤40%, respectively. Among 5103 patients with available EF, 2088 (60%) had HFrEF, and 1284 (25%) had HFpEF. There was no difference in serum sodium level between the groups (HFrEF: 137.4±4.7mmol/L vs. HFpEF: 137.5±5.0mmol/L, P=0.710). Hyponatremic patients had higher in-hospital mortality or urgent heart transplantation in all (11.3% vs. 4.5%, P<0.001), in HFrEF (13.1% vs. 4.9%, P<0.001), and in HFpEF (6.0% vs. 1.9%, P<0.001). After adjustment for significant covariates, hyponatremia was associated with 1.5 fold increased risk for 1-year post-discharge death in the HFrEF group (HR, 1.52; 95% CI, 1.24-1.86), but not in the HFpEF group (HR, 1.16; 95% CI, 0.84-1.61). During admission, the sodium status changed in 22% of the patients and the discharge sodium status had greater prognostic value. CONCLUSIONS: Hyponatremia is independent of HF type. Hyponatremia is a significant risk factor for adverse in-hospital outcomes; however its long-term prognostic value is only limited to patients with HFrEF, but not for those with HFpEF.
BACKGROUND:Hyponatremia is a well-known risk factor for worse outcomes in heart failure (HF) patients. The impact of hyponatremia according to the ejection fraction (EF) is unclear. We evaluated the prognostic value of hyponatremia according to HF type. METHODS AND RESULTS: The Korea Acute Heart Failure (KorAHF) registry consecutively enrolled 5625 patients. Hyponatremia was defined as serum sodium level<135mmol/L at hospital admission. HF with preserved and reduced ejection fraction were defined as an LVEF ≥50% and LVEF ≤40%, respectively. Among 5103 patients with available EF, 2088 (60%) had HFrEF, and 1284 (25%) had HFpEF. There was no difference in serum sodium level between the groups (HFrEF: 137.4±4.7mmol/L vs. HFpEF: 137.5±5.0mmol/L, P=0.710). Hyponatremic patients had higher in-hospital mortality or urgent heart transplantation in all (11.3% vs. 4.5%, P<0.001), in HFrEF (13.1% vs. 4.9%, P<0.001), and in HFpEF (6.0% vs. 1.9%, P<0.001). After adjustment for significant covariates, hyponatremia was associated with 1.5 fold increased risk for 1-year post-discharge death in the HFrEF group (HR, 1.52; 95% CI, 1.24-1.86), but not in the HFpEF group (HR, 1.16; 95% CI, 0.84-1.61). During admission, the sodium status changed in 22% of the patients and the discharge sodium status had greater prognostic value. CONCLUSIONS:Hyponatremia is independent of HF type. Hyponatremia is a significant risk factor for adverse in-hospital outcomes; however its long-term prognostic value is only limited to patients with HFrEF, but not for those with HFpEF.
Authors: Jeremy A Miles; Renato Quispe; Yonatan Mehlman; Kavisha Patel; Claudia Lama Von Buchwald; Jee Young You; Seth Sokol; Robert T Faillace Journal: PLoS One Date: 2019-06-19 Impact factor: 3.240
Authors: Marta Michalska-Kasiczak; Agata Bielecka-Dabrowa; Stephan von Haehling; Stefan D Anker; Jacek Rysz; Maciej Banach Journal: Arch Med Sci Date: 2018-06-11 Impact factor: 3.318