Current Management of Hyponatremia in Acute Heart Failure: A Report From the Hyponatremia Registry for Patients With Euvolemic and Hypervolemic Hyponatremia (HN Registry). Issue 8 (August 2017)

• Record Type: Journal Article
• Authors: Dunlap, Mark E.; Hauptman, Paul J.; Amin, Alpesh N.; Chase, Sandra L.; Chiodo, Joseph A.; Chiong, Jun R.; Dasta, Joseph F.
• Is Part Of: Journal of the American Heart Association. Volume 6:Issue 8(2017)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2017-08
• Subjects: acute heart failure -- fluid restriction -- hypertonic saline -- hyponatremia -- saline -- sodium -- tolvaptan; Heart -- Diseases -- Periodicals; Cardiovascular system -- Diseases -- Periodicals; Cerebrovascular disease -- Periodicals; Cardiology -- Periodicals; 616.1
• DOI: 10.1161/JAHA.116.005261
• Languages: English
• ISSNs: 2047-9980

Abstract

Abstract : Background: Hyponatremia (HN) occurs commonly in patients with acute heart failure and confers a worse prognosis. Current HN treatment varies widely, with no consensus. This study recorded treatment practices currently used for patients hospitalized with acute heart failure and HN. Methods and Results: Data were collected prospectively from 146 US sites on patients hospitalized with acute heart failure and HN (serum sodium concentration [Na + ] ≤130 mEq/L) present at admission or developing in the hospital. Baseline variables, HN treatment, and laboratory values were recorded. Of 762 patients, median [Na + ] was 126 mEq/L (interquartile range, 7) at baseline and increased to 130 mEq/L at discharge. Fluid restriction was the most commonly prescribed therapy (44%), followed by no specific HN treatment beyond therapy for congestion (23%), isotonic saline (5%), tolvaptan (4%), and hypertonic saline (2%). Median rate of change in [Na + ] varied by treatment (0.5 [interquartile range, 1.0] to 2.3 [8.0] mEq/L/d) and median treatment duration ranged from 1 (interquartile range, 1) to 6 (5) days. Fluid restriction and no specific HN treatment resulted in similar changes in [Na + ], and were least effective in correcting HN. Few patients (19%) had [Na + ] ≥135 mEq/L at discharge. Conclusions: The most commonly used treatment approaches for HN (fluid restriction and no specific treatment) in acute heart failure increased [Na + ] minimally, and most patients remained hyponatremic at discharge.