Persistent hypochloremia associated with worse heart failure outcomes

A new study by Shinichi Kurashima and team shows that while resolved hypochloremia and normochloremia showed a similar prognosis, persistent hypochloremia was linked to worse clinical outcomes. The findings of the study were published in the International Journal of Cardiology.

A potential risk for poor consequences in patients with acute heart failure is hypochloremia. Serum chloride levels fluctuate throughout decongestion therapy, however it is unknown how these variations affect prognosis. The study aimed to investigate the relationship between serum chloride levels and decongestion.

For the study, according to their admission and discharge serum chloride levels, a total of 2798 patients with AHF were retrospectively studied and divided into four groups: (1) normochloremia (n=2,192, 78%); (2) treatment-associated hypochloremia, defined as admission normochloremia with a subsequent decrease (98 mEq/L) during hospitalization (n=335, 12%); (3) resolved hypochloremia, defined as admission hypochloremia that disappeared at discharge (n=128, 5%); All-cause mortality was the primary outcome, and cardiovascular death and a composite of cardiovascular death and rehospitalization for heart failure after discharge were the secondary outcomes.

The key findings of the study were:

1. 1584 (57%) of the patients were men, with a mean age of 76 12 years.

2. There was a 46 16% average left ventricular ejection fraction.

3. Persistent hypochloremia was linked to an increased risk of all-cause death, cardiovascular death, and a composite of cardiovascular death and heart failure rehospitalization over the course of a median follow-up period of 365 days (adjusted hazard ratio [95% confidence interval]: 2.27 [1.53-3.37, p 0.001), 2.38 [1.46-3.87, p 0.001, and 1.47 [1.06-2.06, p

4. Patients with resolved hypochloremia and those with normochloremia, however, had comparable results.

Reference:

Kurashima, S., Kitai, T., Matsue, Y., Nogi, K., Kagiyama, N., Oishi, S., Akiyama, E., Suzuki, S., Yamamoto, M., Kida, K., Okumura, T., Nogi, M., Ishihara, S., Ueda, T., Kawakami, R., Furukawa, Y., Saito, Y., & Izumi, C. (2022). Trajectory of serum chloride levels during decongestive therapy in acute heart failure. In International Journal of Cardiology. Elsevier BV. https://doi.org/10.1016/j.ijcard.2022.12.041