Pass the Salt Please: Heart Failure Patients Do Worse Without It, Study Finds

Restricting sodium can actually be detrimental to patients with heart failure, a new analysis found.

Using data from the Heart Failure Adherence and Retention Trial, researchers looked at the sodium intake of 902 patients with class II or class III heart failure and followed them up for a median of 36 months. Writing in JACC: Heart Failure, Rami Doukky, MD and colleagues at Cook County Hospital in Chicago IL and colleagues said it is time to reconsider the standard practice of telling these patients to cut back on salt.

In their study, they were able to track sodium intake for 833 heart failure patients.

“Sodium restriction was associated with significantly higher risk of death or heart failure hospitalization,” they found. One potential weakness of the study is that they relied on food frequency questionnaires, not lab tests, they said.

Though giving up salt has been the cornerstone of traditional recommendations to these patients, “the data supporting this recommendation are thin, leading to inconsistent guidelines from various professional societies,” they wrote.

Sodium restriction was associated with increased risk of death or hospitalization in patients not getting angiotensin converting enzyme inhibitors or angiotensin receptor blockers.

“In symptomatic patients with chronic heart failure, sodium restriction may have a detrimental impact on outcome,” they concluded, but a randomized clinical trial is needed to definitively address that issue.

Discussing their findings, the team wrote that they were surprised to find no evidence that dietary sodium restriction was associated with lower rates of death or heart failure.

Moreover, restricting salt did not show any association with patients having an easier time walking for six minutes, a better quality life, more energy, better physical function, or fewer cardiopulmonary symptoms.

Those findings held up regardless of whether these patients were using diuretics, they noted.

Our findings support further downgrade of the ACCF/AHA sodium restriction recommendation in patients with chronic HF to class IIb (efficacy less well established, conflictive evidence),and press the need for multicenter randomized trial

to definitively address the role of sodium restriction in HF management,” the team concluded.