Clinical question: Is there an association between baseline dietary sodium intake and clinical outcomes in heart failure?
Background: Dietary sodium restriction is common advice for patients with heart failure (HF) to prevent fluid overload and adverse outcomes. The recently published randomized clinical trial, namely SODIUM-HF (published in Lancet in 2022), showed that in ambulatory patients who have HF with either reduced or preserved ejection fraction, a dietary intervention to reduce sodium intake did not reduce cardiovascular (CV)-related hospitalization or all-cause mortality. This secondary analysis of the data collected from the SODIUM-HF trial explores the relationship between baseline dietary sodium intake and clinical outcomes in HF.
Study design: Post hoc exploratory analysis of an international, open-label, randomized, controlled trial, namely SODIUM-HF
Setting: Ambulatory patients from 26 sites in six countries with varied diets over an intervention period of 12 months
Synopsis: The SODIUM-HF trial was conducted between March 2014 and December 2020 and enrolled 806 patients from 26 sites in six countries (Australia, New Zealand, Canada, Chile, Colombia, and Mexico). The patients were randomized into either usual care or a low-sodium diet of less than 100 mmol (i.e., less than 1500 mg) a day over an intervention period of 12 months. The primary outcome was the composite of CV-related hospitalization, CV-related emergency department (ED) visits, and all-cause death measured at 12 and 24 months. Using the data from the SODIUM-HF trial, this secondary analysis focuses on assessing the association between baseline dietary sodium intake and the study outcome and the relationship between change in dietary sodium intake at six months and the study outcomes at 12 and 24 months. In summary, the analysis found that HF patients with higher baseline sodium intake do not necessarily have higher incidence of all-cause mortality, CV-related hospitalization, or ED visits over the monitored period of two years. Furthermore, there is no association between the magnitude of dietary sodium reduction and these HF clinical outcomes. Of note, this post hoc analysis is limited by the data collected in one single clinical randomized trial, in which baseline dietary information and adherence to dietary sodium restriction were self-reported by ambulatory patients.
Bottom line: Baseline dietary sodium intake has no significant impact on clinical outcomes over 24 months in patients with HF.
Citation: Saldarriaga C, et al. Dietary sodium intake and outcomes: a secondary analysis from SODIUM-HF. J Card Fail. 2024;30(9):1073-1082. doi: 10.1016/j.cardfail.2024.04.031.
Dr. Wei is a hospitalist in the department of hospital medicine at the University of California Davis in Sacramento, Calif.