Limiting salt intake does not reduce risk of hospitalization, death in heart failure patients

Practice guidelines have suggested sodium restriction as a nonpharmacologic treatment for the management of heart failure patients. In the study, Justin A. Ezekowitz, University of Alberta, Edmonton, Canada, and colleagues synthesized the data from RCTs investigating the impact of sodium restriction on clinical outcomes in HF patients.

The researchers searched the online databases for this aggregate data meta-analysis up to April 2, 2022. The results of interest were hospitalization, mortality, quality of life, and change in the New York Heart Association (NYHA) functional class. RCTs that investigated the effects of sodium/salt restriction versus no restriction on clinical outcomes in HF patients were included.

Seventeen RCTs comprising 834 in intervention and 871 patients in control groups, respectively, were identified.

The study demonstrated the following findings:

• Sodium restriction did not decrease the risk of hospitalization (odds ratio, 0.84), all-cause death (odds ratio, 0.95), or the composite of death/hospitalization (odds ratio, 0.88).
• The results were comparable in various subgroups, except for the numerically lower death risk with reduced intake of sodium reported in RCTs with dietary sodium at the range of 2000 to 3000 mg/d as opposed to <2000 mg/d (and in RCTs compared to without fluid restriction as a co-intervention).
• Among RCTs reporting the change in New York Heart Association, 2 RCTs (which accounted for two-thirds of the data) demonstrated improvement in NYHA class with sodium restriction.
• Substantial heterogeneity existed for quality of life: 6 RCTs showed improvement in QoL, and 4 RCTs showed no improvement in sodium restriction on QoL.

"Findings from a meta-analysis of RCTs showed that sodium restriction was not linked with fewer hospitalization or deaths in HF patients," the researchers wrote. "Dietary sodium restriction may be tied with improvements in symptoms and QoL."

Reference:

Colin-Ramirez E, Sepehrvand N, Rathwell S, Ross H, Escobedo J, Macdonald P, Troughton R, Saldarriaga C, Lanas F, Doughty R, McAlister FA, Ezekowitz JA. Sodium Restriction in Patients With Heart Failure: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. Circ Heart Fail. 2022 Nov 14:e009879. doi: 10.1161/CIRCHEARTFAILURE.122.009879. Epub ahead of print. PMID: 36373551.