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收缩功能正常的心力衰竭患者的低盐饮食建议及短期转归

Recommendation of Low-Salt Diet and Short-term Outcomes in Heart Failure with Preserved Systolic Function

Hummel SL, DeFranco AC, Skorcz S 2010/3/4 14:18:32

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Am J Med, 2009,

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Background:

Dietary sodium indiscretion frequently contributes to hospitalizations in elderly heart failure patients. Animal models suggest an important role for dietary sodium intake in the pathophysiology of heart failure with preserved systolic function. The documentation and effects of hospital discharge recommendations, particularly for sodium-restricted diet, have not been extensively investigated in heart failure with preserved systolic function.

Methods:

We analyzed 1700 heart failure admissions to Michigan community hospitals. We compared documentation of guideline-based discharge recommendations between preserved systolic function and systolic heart failure patients with chi-squared testing, and used logistic regression to identify predictors of 30-day death and hospital readmission in a prespecified follow-up cohort of 443 patients with preserved systolic function. We hypothesized that patients who received a documented discharge recommendation for sodium-restricted diet would have lower 30-day adverse event rates.

Results:

Heart failure patients with preserved systolic function were significantly less likely than systolic heart failure patients to receive discharge recommendations for weight monitoring (33% vs 43%) and sodium-restricted diet (42% vs 53%). Upon propensity score-adjusted multivariable analysis, patients with preserved systolic function who received a documented sodium-restricted diet recommendation had decreased odds of 30-day combined death and readmission (odds ratio 0.43, 95% confidence interval, 0.24-0.79; P=.007). No other discharge recommendations predicted 30-day outcomes.

Conclusions:

Clinicians document appropriate discharge instructions less frequently in heart failure with preserved systolic function than systolic heart failure. Selected heart failure patients with preserved systolic function who receive advice for sodium-restricted diet may have improved short-term outcomes after hospital discharge (Fig 2).
Figure 2 Figure 2: Comparison of ACC/AHA (American College of Cardiology/American Heart Association) discharge recommendation documentation by heart failure type. Med List=written medication list; Daily Wt=daily weights; Plan/Worse=plan if symptoms worsened; All 6=all 6 standard ACC/AHA discharge recommendations; SRD=sodium-restricted diet; All 7=all standard ACA/AHA discharge recommendations plus sodium-restricted diet. *Denotes significant (P<.02) intergroup difference. (Reprinted from Hummel SL, DeFranco AC, Skorcz S, et al. Recommendation of low-salt diet and short-term outcomes in heart failure with preserved systolic function. Am J Med. 2009;122:1029-1036, with permission from Elsevier Inc.)