Background:Restricting sodium intake, often to less than 2 grams a day, is generally accepted to be an important component of the management of heart failure. However, precise data on patient knowledge of this issue and patient application of such knowledge i~ limited. Furthermore concern has been expressed about the potential to alter knowledge and behaviour in an elderly population.Aims: To assess the benefits of intensive dietetic consultation on patient understanding and adherence of sodium restriction in an elderly (class IV) heart failure population.Methods: As part of an ongoing study we randomised sequential admissions with heart failure to either routine care (RC) or multidisciplinary care (MC). The MC group received specialised dietetic consultation in-hospital and at outpatient follow-up. Dietetic advice for the RC group was at the discretion of the attending physician. Patients' knowledge of sodium restriction was assessed by questionnaire (percent correct from 10 questions) on enrolment and at 3 months following discharge from hospital. Sodium ingestion (average daily intake in grams over a period of one week) was analysed at the same time-points using dietary assessment.Results: This is an early report on the first 79 patients (RC n = 42, MC n = 38; mean age 70 years). Knowledge of sodium restriction and sodium ingestion was similar in both groups at baseline (knowledge: RC 65 4-19% versus MC 59 4-16%, p = 0.20; sodium ingestion: 10.4 4-4.5 versus 9.7 4-2.9 g/day, p = 0.45). In the RC group neither knowledge nor sodium ingestion had changed at three months (knowledge: 69 4-22%, p = 0.43; sodium ingestion: 9.1 4-3.3 g/day, p = 0.20). In the MC group both parameters had improved significantly at three months compared to baseline (knowledge: 82 4-19%, p < 0.0001; sodium ingestion: 5.5 4-2.0 g/day, p < 0.0001) and to the RC group (both parameters p < 0.0001).Conclusion: These data demonstrate that specialised intensive in-patient and out-patient dietary consultation can significantly improve the understanding and application of sodium restriction in an elderly heart failure population. The impact of these observations on morbidity is the subject of ongoing investigation.

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