Sodium Restriction Counseling Reduces Cardiac Events in Patients With Heart Failure

Abstract

Patients and Study DesignThe study recruited 800 consecutive patients with HF who were hospitalized between 2018 and 2019 at the Gunma Prefectural Cardiovascular Center. After excluding patients who died during hospitalization, 743 patients who were discharged were enrolled.SRC was conducted by professional nutritionists (registered dietitians) to help HF patients reduce salt intake to <6 g/day after discharge. The counseling session was held once during HF hospitalization, and session lasted at least 30 min. Patients were followed up after discharge to record any deaths or HF rehospitalization events, which were analyzed as outcomes, together with the combined outcome of with or without SRC.

Fluid and Salt Balance and the Role of Nutrition in Heart Failure

“…High sodium intake has been related with volume retention, high blood pressure, and increased cardiovascular morbidity. Data from studies introducing low sodium intake diets, such as the Dietary Approaches to Stop Hypertension (DASH) diet, present a significant decrease in all-cause mortality and the risk of adverse cardiac events [ 5 , 6 ]. There are some concerns in the case of heart failure patients, as they are usually advised to follow a low sodium diet; many of the people who consume a low sodium diet are more likely to have heart failure compared to the general population.…”

“…Additionally, an excessive correction of serum sodium should be avoided, and the recommended correction of >6 to 8 mmol/L per 24 h should be maintained in the hyponatremic patient [ 25 , 26 ]. Recent ESC guidelines for heart failure refer to cautious fluid administration in patients with AHF, especially in the setting of isolated right heart failure, to improve peripheral hypoperfusion with a class IIb indication [ 6 ].…”

Behavior Change and Prognosis in Patients With Heart Failure ― Salt Reduction Guidance and Readiness for Heart Failure Treatment ―

“…In this study, the prognosis of HF patients in the non-active states (precontemplation, contemplation, and preparation stages) was good. 4 The differences in the backgrounds of HF patients need consideration. The health interventions…”

“…Assessment of an HF patient's behavioral change allows physicians to understand the patient's psychological state, and, in turn, provide a tailored and person-centered approach to the patient. In their study, 4 the salt intake of the patients was not calculated, and only a one-time salt reduction guidance session lasting about 30 min during the hospitalization was performed. Thus, the authors cannot declare that receiving salt reduction instruction directly improved the patient's prognosis.…”

“…In this issue of the Journal, Nakajima et al 4 provide a new perspective on the relationship between a behavior change model and the prognosis of HF patients receiving salt reduction guidance. The behavior change model is one of the health theories advocated by Prochaska et al In the behavioral transformation stage model, for a person to change a behavior, there are 5 stages to go through: "precontemplation" → "contemplation" → "preparation" → "action" → "maintenance".…”