Search Here

Strict sodium intake guidelines for heart failure patients do not offer significant clinical benefits, according to a recent review. Instead, researchers suggest that moderate sodium consumption is more practical and beneficial for improving the quality of life and functional status in these patients.

A review of multiple studies, conducted by Paolo Raggi, MD, from the University of Alberta, Edmonton, Canada, indicates that while severe sodium restriction has long been recommended, it does not save lives or prevent hospital admissions.

Dr. Raggi's narrative review, published in the European Journal of Clinical Investigation, advocates for a moderate daily sodium intake of 3.0 to 4.5 grams. This level, he asserts, is more manageable for patients and can enhance their quality of life.

Dr. Raggi's work was partly inspired by the SODIUM-HF study, a large, multicenter trial that found sodium restriction did not reduce mortality, cardiovascular hospitalizations, or emergency visits but did improve the quality of life and New York Heart Association class.

He also highlighted that excessive fluid restriction, often taught as a standard practice, does not reduce mortality or hospitalizations and causes undue stress and discomfort for patients.

In the review, Dr. Raggi and his team analyzed literature from 2000 to 2021, focusing on studies involving heart failure, salt, sodium, and fluid intake. The reviewed trials, although varied in their interventions and participant demographics, consistently showed no reduction in mortality or hospitalization rates from severe sodium restriction.

The SODIUM-HF trial, which targeted a sodium intake of 1.5 grams per day, was terminated early due to its ineffectiveness and complications arising from the COVID-19 pandemic.

The review suggests a moderate sodium intake of 2 to 3 grams per day may be more suitable for most heart failure patients, particularly those with chronic kidney disease, where sodium management is crucial.

"A more aggressive sodium restriction may be necessary in the presence of chronic kidney disease, where the handling of sodium by the kidneys is hampered," Raggi explained, Medscape reported. "The debate on tight sodium restriction in heart failure continues to appear in major medical journals, yet it would seem that after many years of controversy, the time has come to close it."

Dr. Johanna Contreras, an advanced heart failure and transplant cardiologist at Mount Sinai Fuster Heart Hospital, emphasized that sodium restriction is difficult to standardize due to variability in patients' diets and the accuracy of dietary recall questionnaires.

She noted that heart failure has diverse causes and stages, making a one-size-fits-all approach impractical. Patients with advanced heart failure or secondary hypertension are particularly susceptible to the adverse effects of high sodium intake, which can exacerbate symptoms and increase morbidity and mortality.

"It is important to understand the kinds of patients we are referring to, how advanced they are, and what comorbidities the patients have," Contreras said. "We also know that there are race, ethnicity, and gender differences in sensitivity to sodium."

Contreras is advocating for a balanced approach, encouraging patients to consume fresh fruits and vegetables and be mindful of processed foods and added table salt.

Overall, the review calls for a shift from severe sodium restriction to a more moderate and individualized approach in treating heart failure patients.