Umair Khalid, MD; Anita Deswal, MD, MPH
In patients with systolic heart failure (HF), what are the effects of a restricted-sodium diet compared with a normal-sodium diet?
Included studies compared dietary interventions that restricted salt intake or advised reduced salt intake with placebo or control diet or no intervention in patients ≥ 18 years of age with systolic HF (left ventricular ejection fraction < 40%); had ≥ 1 month of follow-up; ≥ 90 patients; and reported mortality (all-cause, sudden death, and HF-related) or hospital readmission for HF.
MEDLINE, EMBASE/Excerpta Medica, Cochrane Central Register of Controlled Trials, Web of Science, Scopus, Google Scholar (all to Apr 2012); reference lists; and reviews were searched for English-language, randomized, controlled trials (RCTs). 6 RCTs (n = 2747, median age 74 y, 63% men, median follow-up 584 d; range of follow-up 30 d to 57 mo) met selection criteria. All trials had adequate randomization and allocation concealment and used intention-to-treat analysis. Outcome assessors (6 RCTs), care providers (5 RCTs), and patients (4 RCTs) were blinded. All patients in all RCTs received multiple written standard diets designed by dietitians, differing only in sodium content: low sodium (1.8 g/d) or normal sodium (2.8 g/d). In 5 RCTs, fluid intake was restricted to 1 L/d in all patients.
Risks for mortality (all-cause, sudden death, and HF-related) and hospital readmission for HF were increased in patients receiving low-sodium diets compared with normal-sodium diets.
In patients with systolic heart failure (HF), low-sodium diets (1.8 g/d) increase mortality and hospital readmission for HF compared with normal-sodium diets (2.8 g/d).
Low-sodium vs normal-sodium diets in patients with systolic heart failure (HF)*
*Abbreviations defined in Glossary. Weighted event rates, RRI, and CI calculated from relative risks and control event rates in article using a random-effects model.
Khalid U, Deswal A. Review: In systolic heart failure, low-sodium diets increase mortality compared with normal-sodium diets. Ann Intern Med. 2013;158:JC7. doi: 10.7326/0003-4819-158-4-201302190-02007
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Published: Ann Intern Med. 2013;158(4):JC7.
Cardiology, Heart Failure.
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