Racial differences and mortality risk in patients with heart failure and hyponatremia

Abstract

Background Hyponatremia is a well-established poor prognostic marker in patients with heart failure. Whether the mortality risk is comparable among different races of patients with heart failure and hyponatremia is unknown. Materials and methods Consecutive patients admitted with acute decompensated heart failure and an admission sodium level<135 mEq/L from 1/1/2001 through 12/31/10 were identified. Patients were divided into four groups based on self-reported race: white, African American, Hispanic and other. African Americans were used as the reference group for statistical analysis. The primary outcome was all-cause mortality. Results We included 4,343 patients, from which 1,356 (31%) identified as white, 1,248 (29%) as African American, 780 (18%) as Hispanic and 959 (22%) as other. During a median follow-up of 23 months, a total of 2,384 patients died: 678 were African American, 820 were white, 298 were Hispanic and 588 were other. After adjusting for baseline demographics, comorbidities and medication use, Hispanic patients had a 45% less risk of death as compared to African Americans (HR .55, CI .48-.64, p<0.05). There was no difference in mortality between white and African American patients (HR 1.04, CI .92–1.2, p = 0.79). Conclusion Hispanic patients admitted for heart failure and who were hyponatremic on admission had an independent lower risk of mortality compared to other groups. These findings may be due to the disparate activity of the renin-angiotensin-aldosterone system among various racial groups. This observational study is hypothesis generating and suggests that treatment of patients with heart failure and hyponatremia should perhaps be focused more on renin-angiotensin-aldosterone system reduction in certain racial groups, yet less in others.

Validation and derivation of short-term prognostic risk score in acute decompensated heart failure in China

“…For these purposes, several prognostic risk scores (PRSs) in patients with HF have been developed [10][11][12][13]. However, most of these scores have not been thoroughly externally validated and the effective values of predictors are differ among races and regions [14,15]. Moreover, current scoring systems paid less attention to outcomes in patients with ADHF during the vulnerable phase, and it is unclear whether they can be directly applied to ADHF patients.…”

Dysnatremia is associated with increased risk of all-cause mortality within 365 days post-discharge in patients with atrial fibrillation without heart failure: A prospective cohort study

“…Dysnatremia, including hyponatremia and hypernatremia, is very common in hospitalized patients ( 13 , 14 ) and complications of acute diseases, and results from interventions during patient treatment ( 15 , 16 ) or exists as a comorbid condition ( 17 ). Previous studies have shown that abnormal serum sodium concentrations are independent factors for poor prognosis of internal medicine patients ( 18 – 20 ) and patients with cardiac diseases ( 14 , 21 , 22 ). Studies show that patients with HF with AF frequently present with hyponatremia ( 23 , 24 ), which is associated with high mortality ( 25 ).…”