DOI QR코드

DOI QR Code

Prognostic value of hyponatremia in heart failure patients: an analysis of the Clinical Characteristics and Outcomes in the Relation with Serum Sodium Level in Asian Patients Hospitalized for Heart Failure (COAST) study

  • Yoo, Byung-Su (Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine) ;
  • Park, Jin Joo (Cardiovascular Center, Seoul National University Bundang Hospital) ;
  • Choi, Dong-Ju (Cardiovascular Center, Seoul National University Bundang Hospital) ;
  • Kang, Seok-Min (Department of Internal Medicine, Severance Hospital, Yonsei University Health System) ;
  • Hwang, Juey-Jen (Department of Internal Medicine, National Taiwan University Hospital) ;
  • Lin, Shing-Jong (Department of Internal Medicine, Taipei Veterans General Hospital) ;
  • Wen, Ming-Shien (Department of Internal Medicine, Chang Gung Memorial Hospital) ;
  • Zhang, Jian (Department of Internal Medicine, Fuwai Hospital) ;
  • Ge, Junbo (Department of Internal Medicine, Zhongshan Hospital) ;
  • COAST investigators (COAST)
  • Received : 2014.04.06
  • Accepted : 2014.09.22
  • Published : 2015.07.01

Abstract

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 $138{\pm}4.7mmol/L$, 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 ${\beta}-blocker$. 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.

Keywords

References

  1. Lee DS, Austin PC, Rouleau JL, Liu PP, Naimark D, Tu JV. Predicting mortality among patients hospitalized for heart failure: derivation and validation of a clinical model. JAMA 2003;290:2581-2587. https://doi.org/10.1001/jama.290.19.2581
  2. Kearney MT, Fox KA, Lee AJ, et al. Predicting death due to progressive heart failure in patients with mild-to-moderate chronic heart failure. J Am Coll Cardiol 2002;40:1801-1808. https://doi.org/10.1016/S0735-1097(02)02490-7
  3. Senni M, De Maria R, Gregori D, et al. Temporal trends in survival and hospitalizations in outpatients with chronic systolic heart failure in 1995 and 1999. J Card Fail 2005;11:270-278. https://doi.org/10.1016/j.cardfail.2004.11.003
  4. Harjola VP, Follath F, Nieminen MS, et al. Characteristics, outcomes, and predictors of mortality at 3 months and 1 year in patients hospitalized for acute heart failure. Eur J Heart Fail 2010;12:239-248. https://doi.org/10.1093/eurjhf/hfq002
  5. Gheorghiade M, Gattis WA, O’Connor CM, et al. Effects of tolvaptan, a vasopressin antagonist, in patients hospitalized with worsening heart failure: a randomized controlled trial. JAMA 2004;291:1963-1971. https://doi.org/10.1001/jama.291.16.1963
  6. Gheorghiade M, Abraham WT, Albert NM, et al. Relationship between admission serum sodium concentration and clinical outcomes in patients hospitalized for heart failure: an analysis from the OPTIMIZE-HF registry. Eur Heart J 2007;28:980-988. https://doi.org/10.1093/eurheartj/ehl542
  7. Klein L, O'Connor CM, Leimberger JD, et al. Lower serum sodium is associated with increased short-term mortality in hospitalized patients with worsening heart failure: results from the Outcomes of a Prospective Trial of Intravenous Milrinone for Exacerbations of Chronic Heart Failure (OPTIME-CHF) study. Circulation 2005;111:2454-2460. https://doi.org/10.1161/01.CIR.0000165065.82609.3D
  8. Abraham WT, Fonarow GC, Albert NM, et al. Predictors of in-hospital mortality in patients hospitalized for heart failure: insights from the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF). J Am Coll Cardiol 2008;52:347-356. https://doi.org/10.1016/j.jacc.2008.04.028
  9. Schrier RW, Abraham WT. Hormones and hemodynamics in heart failure. N Engl J Med 1999;341:577-585. https://doi.org/10.1056/NEJM199908193410806
  10. Schrier RW, Berl T. Mechanism of effect of alpha adrenergic stimulation with norepinephrine on renal water excretion. J Clin Invest 1973;52:502-511. https://doi.org/10.1172/JCI107207
  11. Schrier RW, Berl T, Anderson RJ. Osmotic and non-osmotic control of vasopressin release. Am J Physiol 1979;236:F321-F332.
  12. Goldsmith SR, Francis GS, Cowley AW Jr. Arginine vasopressin and the renal response to water loading in congestive heart failure. Am J Cardiol 1986;58:295-299. https://doi.org/10.1016/0002-9149(86)90065-2
  13. Schrier RW, Gross P, Gheorghiade M, et al. Tolvaptan, a selective oral vasopressin V2-receptor antagonist, for hyponatremia. N Engl J Med 2006;355:2099-2112. https://doi.org/10.1056/NEJMoa065181
  14. Udelson JE, McGrew FA, Flores E, et al. Multicenter, randomized, double-blind, placebo-controlled study on the effect of oral tolvaptan on left ventricular dilation and function in patients with heart failure and systolic dysfunction. J Am Coll Cardiol 2007;49:2151-2159. https://doi.org/10.1016/j.jacc.2007.01.091
  15. Konstam MA, Gheorghiade M, Burnett JC Jr, et al. Effects of oral tolvaptan in patients hospitalized for worsening heart failure: the EVEREST Outcome Trial. JAMA 2007;297:1319-1331. https://doi.org/10.1001/jama.297.12.1319
  16. Lee WH, Packer M. Prognostic importance of serum sodium concentration and its modification by converting- enzyme inhibition in patients with severe chronic heart failure. Circulation 1986;73:257-267. https://doi.org/10.1161/01.CIR.73.2.257
  17. Packer M, Medina N, Yushak M. Relation between serum sodium concentration and the hemodynamic and clinical responses to converting enzyme inhibition with captopril in severe heart failure. J Am Coll Cardiol 1984;3:1035-1043. https://doi.org/10.1016/S0735-1097(84)80364-2
  18. Riegger GA, Kochsiek K. Vasopressin, renin and norepinephrine levels before and after captopril administration in patients with congestive heart failure due to idiopathic dilated cardiomyopathy. Am J Cardiol 1986;58:300-303. https://doi.org/10.1016/0002-9149(86)90066-4
  19. Packer M, Lee WH, Kessler PD, Medina N, Yushak M, Gottlieb SS. Identification of hyponatremia as a risk factor for the development of functional renal insufficiency during converting enzyme inhibition in severe chronic heart failure. J Am Coll Cardiol 1987;10:837-844. https://doi.org/10.1016/S0735-1097(87)80278-4
  20. Jessup M, Abraham WT, Casey DE, et al. 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation. Circulation 2009;119:1977-2016. https://doi.org/10.1161/CIRCULATIONAHA.109.192064
  21. Lee SE, Choi DJ, Yoon CH, et al. Improvement of hyponatraemia during hospitalisation for acute heart failure is not associated with improvement of prognosis: an analysis from the Korean Heart Failure (KorHF) registry. Heart 2012;98:1798-1804. https://doi.org/10.1136/heartjnl-2012-302334

Cited by

  1. Impact of hyponatremia on mortality and morbidity in patients with COPD exacerbations vol.117, pp.None, 2015, https://doi.org/10.1016/j.rmed.2016.05.003
  2. Gap Between Clinical Practice and Guidelines: A National Survey of the Knowledge of Recommended Heart Failure Guidelines Among Chinese Physicians vol.26, pp.4, 2017, https://doi.org/10.1097/qmh.0000000000000150
  3. Racial differences and mortality risk in patients with heart failure and hyponatremia vol.14, pp.6, 2015, https://doi.org/10.1371/journal.pone.0218504
  4. Hyponatremia in Heart Failure: Pathogenesis and Management vol.15, pp.4, 2015, https://doi.org/10.2174/1573403x15666190306111812
  5. Gender difference in the impact of Ischaemic heart disease on heart failure vol.50, pp.5, 2015, https://doi.org/10.1111/eci.13232
  6. Prognostic value of serum hyponatremia for outcomes in patients with heart failure with preserved ejection fraction: An observational cohort study vol.20, pp.5, 2015, https://doi.org/10.3892/etm.2020.9231
  7. Hyponatremia and Renal Venous Congestion in Heart Failure Patients vol.2021, pp.None, 2015, https://doi.org/10.1155/2021/6499346
  8. Laboratory prognostic score for predicting 14-day mortality in terminally ill patients with gynecologic malignancy vol.26, pp.7, 2015, https://doi.org/10.1007/s10147-021-01923-x
  9. A non-linear ensemble model-based surgical risk calculator for mixed data from multiple surgical fields vol.21, pp.suppl2, 2015, https://doi.org/10.1186/s12911-021-01450-9