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. 2023 Sep;25(9):1571-1583.
doi: 10.1002/ejhf.2873. Epub 2023 May 23.

Hyponatraemia and changes in natraemia during hospitalization for acute heart failure and associations with in-hospital and long-term outcomes - from the ESC-HFA EORP Heart Failure Long-Term Registry

Agnieszka Kapłon-Cieślicka  1 , Lina Benson  2 , Ovidiu Chioncel  3 , Maria G Crespo-Leiro  4 , Andrew J S Coats  5 , Stefan D Anker  6 , Frank Ruschitzka  7 , Camilla Hage  2   8 , Jarosław Drożdż  9 , Petar Seferovic  10 , Giuseppe M C Rosano  11 , Massimo Piepoli  12 , Alexandre Mebazaa  13 , Theresa McDonagh  14 , Mitja Lainscak  15 , Gianluigi Savarese  2   8 , Roberto Ferrari  16 , Wilfried Mullens  17 , Antoni Bayes-Genis  18 , Aldo P Maggioni  19 , Lars H Lund  2   8 ; on behalf of the Heart Failure Association (HFA) of the European Society of Cardiology (ESC) and the ESC Heart Failure Long-Term Registry Investigators
Collaborators, Affiliations
Free article

Hyponatraemia and changes in natraemia during hospitalization for acute heart failure and associations with in-hospital and long-term outcomes - from the ESC-HFA EORP Heart Failure Long-Term Registry

Agnieszka Kapłon-Cieślicka et al. Eur J Heart Fail. 2023 Sep.
Free article

Abstract

Aims: To comprehensively assess hyponatraemia in acute heart failure (AHF) regarding prevalence, associations, hospital course, and post-discharge outcomes.

Methods and results: Of 8298 patients in the European Society of Cardiology Heart Failure Long-Term Registry hospitalized for AHF with any ejection fraction, 20% presented with hyponatraemia (serum sodium <135 mmol/L). Independent predictors included lower systolic blood pressure, estimated glomerular filtration rate (eGFR) and haemoglobin, along with diabetes, hepatic disease, use of thiazide diuretics, mineralocorticoid receptor antagonists, digoxin, higher doses of loop diuretics, and non-use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and beta-blockers. In-hospital death occurred in 3.3%. The prevalence of hyponatraemia and in-hospital mortality with different combinations were: 9% hyponatraemia both at admission and discharge (hyponatraemia Yes/Yes, in-hospital mortality 6.9%), 11% Yes/No (in-hospital mortality 4.9%), 8% No/Yes (in-hospital mortality 4.7%), and 72% No/No (in-hospital mortality 2.4%). Correction of hyponatraemia was associated with improvement in eGFR. In-hospital development of hyponatraemia was associated with greater diuretic use and worsening eGFR but also more effective decongestion. Among hospital survivors, 12-month mortality was 19% and adjusted hazard ratios (95% confidence intervals) were for hyponatraemia Yes/Yes 1.60 (1.35-1.89), Yes/No 1.35 (1.14-1.59), and No/Yes 1.18 (0.96-1.45). For death or heart failure hospitalization they were 1.38 (1.21-1.58), 1.17 (1.02-1.33), and 1.09 (0.93-1.27), respectively.

Conclusion: Among patients with AHF, 20% had hyponatraemia at admission, which was associated with more advanced heart failure and normalized in half of patients during hospitalization. Admission hyponatraemia (possibly dilutional), especially if it did not resolve, was associated with worse in-hospital and post-discharge outcomes. Hyponatraemia developing during hospitalization (possibly depletional) was associated with lower risk.

Keywords: Acute heart failure; Congestion; Hyponatraemia; Prognosis; Sodium; Worsening heart failure.

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