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European Heart Journal Advance Access originally published online on February 19, 2007
European Heart Journal 2007 28(8):980-988; doi:10.1093/eurheartj/ehl542
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© The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Relationship between admission serum sodium concentration and clinical outcomes in patients hospitalized for heart failure: an analysis from the OPTIMIZE-HF registry

Mihai Gheorghiade1,*, William T. Abraham2, Nancy M. Albert3, Wendy Gattis Stough4,5, Barry H. Greenberg6, Christopher M. O'Connor7, Lilin She8, Clyde W. Yancy9, James Young10, Gregg C. Fonarow on behalf of the OPTIMIZE-HF Investigators and Coordinators11,{dagger}

1 Division of Cardiology, Feinberg School of Medicine, Northwestern University, Galter 10-240, 201 E Huron Street, Chicago, IL 60611, USA
2 Division of Cardiology, The Ohio State University, Columbus, OH, USA
3 George M. and Linda H. Kaufman Center for Heart Failure, Cleveland Clinic Foundation, Cleveland, OH, USA
4 Department of Medicine, Duke University Medical Center, Durham, NC, USA
5 Department of Clinical Research, Campbell University School of Pharmacy, Research Triangle Park, NC, USA
6 Department of Medicine, UCSD Medical Center, San Diego, CA, USA
7 Division of Cardiology, Duke University Medical Center/Duke Clinical Research Institute, Durham, NC, USA
8 Duke Clinical Research Institute, Durham, NC, USA
9 Baylor University Medical Center, Baylor Heart and Vascular Institute, Dallas, TX, USA
10 Heart Failure Section, Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
11 Department of Medicine, UCLA Medical Center, Los Angeles, CA, USA

Received 30 June 2006; revised 27 December 2006; accepted 25 January 2007; online publish-ahead-of-print 19 February 2007.

* Corresponding author: Tel: +1 312 695 0051; fax: +1 312 695 1434. E-mail address: m-gheorghiade{at}northwestern.edu

See page 920 for the editorial comment on this article (doi:10.1093/eurheartj/ehm046)

Aims: Hyponatraemia has been shown to be an independent predictor of mortality in selected patients with heart failure enrolled in clinical trials. The predictive value of hyponatraemia has not been evaluated in unselected patients hospitalized with heart failure.

Methods and results: OPTIMIZE-HF is a registry and performance-improvement programme for patients hospitalized with heart failure and includes a subgroup with 60–90 day follow-up data. The relationship between admission serum sodium concentration and clinical outcomes was analysed in 48 612 patients from 259 hospitals. Admission serum sodium levels were analysed both as a continuous variable and by grouping patients with admission Na < 135 and Na ≥ 135 mmol/L. Patients with hyponatraemia (Na <135 mmol/L) at the time of hospital admission had modest differences in baseline clinical characteristics and management during hospitalization compared with patients who had serum sodium ≥135 mmol/L. Patients with hyponatraemia were more likely to be Caucasian, have lower admission systolic blood pressure, and receive intravenous inotropes during hospitalization. Patients with hyponatraemia had significantly higher rates of in-hospital and follow-up mortality and longer hospital stays, although no difference in re-admission rates was observed. After adjusting for differences with multivariable analysis, the risk of in-hospital death increased by 19.5%, the risk of follow-up mortality by 10%, and the risk of death or rehospitalization by 8% for each 3 mmol/L decrease in admission serum sodium below 140 mmol/L.

Conclusion: Hyponatraemia in hospitalized patients with heart failure is relatively common and is associated with longer hospital stays and higher in-hospital and early post-discharge mortality. Re-admission rates were equally high in patients with or without hyponatraemia.

Key Words: Serum sodium • Heart failure • Registry • Risk factors • Hospitalization

{dagger} The Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF) registry is registered: www.clinicaltrials.gov, study number NCT00344513 [ClinicalTrials.gov] .


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