Short and long-term prognostic value of hyponatremia in heart failure with preserved ejection fraction versus reduced ejection fraction: An analysis of the Korean Acute Heart Failure registry

Jin Joo Park, Young Jin Cho, Il Young Oh, Hyun Ah Park, Hae Young Lee, Kye Hun Kim, Byung Su Yoo, Seok Min Kang, Sang Hong Baek, Eun Seok Jeon, Jae Joong Kim, Myeong Chan Cho, Shung Chull Chae, Byung Hee Oh, Dong Ju Choi

Research output: Contribution to journalArticle

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Abstract

Background Hyponatremia is a well-known risk factor for worse outcomes in heart failure (HF) patients. The impact of hyponatremia according to the ejection fraction (EF) is unclear. We evaluated the prognostic value of hyponatremia according to HF type. Methods and results The Korea Acute Heart Failure (KorAHF) registry consecutively enrolled 5625 patients. Hyponatremia was defined as serum sodium level < 135 mmol/L at hospital admission. HF with preserved and reduced ejection fraction were defined as an LVEF ≥ 50% and LVEF ≤ 40%, respectively. Among 5103 patients with available EF, 2088 (60%) had HFrEF, and 1284 (25%) had HFpEF. There was no difference in serum sodium level between the groups (HFrEF: 137.4 ± 4.7 mmol/L vs. HFpEF: 137.5 ± 5.0 mmol/L, P = 0.710). Hyponatremic patients had higher in-hospital mortality or urgent heart transplantation in all (11.3% vs. 4.5%, P < 0.001), in HFrEF (13.1% vs. 4.9%, P < 0.001), and in HFpEF (6.0% vs. 1.9%, P < 0.001). After adjustment for significant covariates, hyponatremia was associated with 1.5 fold increased risk for 1-year post-discharge death in the HFrEF group (HR, 1.52; 95% CI, 1.24–1.86), but not in the HFpEF group (HR, 1.16; 95% CI, 0.84–1.61). During admission, the sodium status changed in 22% of the patients and the discharge sodium status had greater prognostic value. Conclusions Hyponatremia is independent of HF type. Hyponatremia is a significant risk factor for adverse in-hospital outcomes; however its long-term prognostic value is only limited to patients with HFrEF, but not for those with HFpEF.

Original languageEnglish
Pages (from-to)239-245
Number of pages7
JournalInternational Journal of Cardiology
Volume248
DOIs
Publication statusPublished - 2017 Dec 1

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Hyponatremia
Registries
Heart Failure
Sodium
Patient Discharge
Heart Transplantation
Korea
Hospital Mortality
Serum

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Park, Jin Joo ; Cho, Young Jin ; Oh, Il Young ; Park, Hyun Ah ; Lee, Hae Young ; Kim, Kye Hun ; Yoo, Byung Su ; Kang, Seok Min ; Baek, Sang Hong ; Jeon, Eun Seok ; Kim, Jae Joong ; Cho, Myeong Chan ; Chae, Shung Chull ; Oh, Byung Hee ; Choi, Dong Ju. / Short and long-term prognostic value of hyponatremia in heart failure with preserved ejection fraction versus reduced ejection fraction : An analysis of the Korean Acute Heart Failure registry. In: International Journal of Cardiology. 2017 ; Vol. 248. pp. 239-245.
@article{f5d137f8cfde4480841f7bd25d2a9784,
title = "Short and long-term prognostic value of hyponatremia in heart failure with preserved ejection fraction versus reduced ejection fraction: An analysis of the Korean Acute Heart Failure registry",
abstract = "Background Hyponatremia is a well-known risk factor for worse outcomes in heart failure (HF) patients. The impact of hyponatremia according to the ejection fraction (EF) is unclear. We evaluated the prognostic value of hyponatremia according to HF type. Methods and results The Korea Acute Heart Failure (KorAHF) registry consecutively enrolled 5625 patients. Hyponatremia was defined as serum sodium level < 135 mmol/L at hospital admission. HF with preserved and reduced ejection fraction were defined as an LVEF ≥ 50{\%} and LVEF ≤ 40{\%}, respectively. Among 5103 patients with available EF, 2088 (60{\%}) had HFrEF, and 1284 (25{\%}) had HFpEF. There was no difference in serum sodium level between the groups (HFrEF: 137.4 ± 4.7 mmol/L vs. HFpEF: 137.5 ± 5.0 mmol/L, P = 0.710). Hyponatremic patients had higher in-hospital mortality or urgent heart transplantation in all (11.3{\%} vs. 4.5{\%}, P < 0.001), in HFrEF (13.1{\%} vs. 4.9{\%}, P < 0.001), and in HFpEF (6.0{\%} vs. 1.9{\%}, P < 0.001). After adjustment for significant covariates, hyponatremia was associated with 1.5 fold increased risk for 1-year post-discharge death in the HFrEF group (HR, 1.52; 95{\%} CI, 1.24–1.86), but not in the HFpEF group (HR, 1.16; 95{\%} CI, 0.84–1.61). During admission, the sodium status changed in 22{\%} of the patients and the discharge sodium status had greater prognostic value. Conclusions Hyponatremia is independent of HF type. Hyponatremia is a significant risk factor for adverse in-hospital outcomes; however its long-term prognostic value is only limited to patients with HFrEF, but not for those with HFpEF.",
author = "Park, {Jin Joo} and Cho, {Young Jin} and Oh, {Il Young} and Park, {Hyun Ah} and Lee, {Hae Young} and Kim, {Kye Hun} and Yoo, {Byung Su} and Kang, {Seok Min} and Baek, {Sang Hong} and Jeon, {Eun Seok} and Kim, {Jae Joong} and Cho, {Myeong Chan} and Chae, {Shung Chull} and Oh, {Byung Hee} and Choi, {Dong Ju}",
year = "2017",
month = "12",
day = "1",
doi = "10.1016/j.ijcard.2017.08.004",
language = "English",
volume = "248",
pages = "239--245",
journal = "International Journal of Cardiology",
issn = "0167-5273",
publisher = "Elsevier Ireland Ltd",

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Short and long-term prognostic value of hyponatremia in heart failure with preserved ejection fraction versus reduced ejection fraction : An analysis of the Korean Acute Heart Failure registry. / Park, Jin Joo; Cho, Young Jin; Oh, Il Young; Park, Hyun Ah; Lee, Hae Young; Kim, Kye Hun; Yoo, Byung Su; Kang, Seok Min; Baek, Sang Hong; Jeon, Eun Seok; Kim, Jae Joong; Cho, Myeong Chan; Chae, Shung Chull; Oh, Byung Hee; Choi, Dong Ju.

In: International Journal of Cardiology, Vol. 248, 01.12.2017, p. 239-245.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Short and long-term prognostic value of hyponatremia in heart failure with preserved ejection fraction versus reduced ejection fraction

T2 - An analysis of the Korean Acute Heart Failure registry

AU - Park, Jin Joo

AU - Cho, Young Jin

AU - Oh, Il Young

AU - Park, Hyun Ah

AU - Lee, Hae Young

AU - Kim, Kye Hun

AU - Yoo, Byung Su

AU - Kang, Seok Min

AU - Baek, Sang Hong

AU - Jeon, Eun Seok

AU - Kim, Jae Joong

AU - Cho, Myeong Chan

AU - Chae, Shung Chull

AU - Oh, Byung Hee

AU - Choi, Dong Ju

PY - 2017/12/1

Y1 - 2017/12/1

N2 - Background Hyponatremia is a well-known risk factor for worse outcomes in heart failure (HF) patients. The impact of hyponatremia according to the ejection fraction (EF) is unclear. We evaluated the prognostic value of hyponatremia according to HF type. Methods and results The Korea Acute Heart Failure (KorAHF) registry consecutively enrolled 5625 patients. Hyponatremia was defined as serum sodium level < 135 mmol/L at hospital admission. HF with preserved and reduced ejection fraction were defined as an LVEF ≥ 50% and LVEF ≤ 40%, respectively. Among 5103 patients with available EF, 2088 (60%) had HFrEF, and 1284 (25%) had HFpEF. There was no difference in serum sodium level between the groups (HFrEF: 137.4 ± 4.7 mmol/L vs. HFpEF: 137.5 ± 5.0 mmol/L, P = 0.710). Hyponatremic patients had higher in-hospital mortality or urgent heart transplantation in all (11.3% vs. 4.5%, P < 0.001), in HFrEF (13.1% vs. 4.9%, P < 0.001), and in HFpEF (6.0% vs. 1.9%, P < 0.001). After adjustment for significant covariates, hyponatremia was associated with 1.5 fold increased risk for 1-year post-discharge death in the HFrEF group (HR, 1.52; 95% CI, 1.24–1.86), but not in the HFpEF group (HR, 1.16; 95% CI, 0.84–1.61). During admission, the sodium status changed in 22% of the patients and the discharge sodium status had greater prognostic value. Conclusions Hyponatremia is independent of HF type. Hyponatremia is a significant risk factor for adverse in-hospital outcomes; however its long-term prognostic value is only limited to patients with HFrEF, but not for those with HFpEF.

AB - Background Hyponatremia is a well-known risk factor for worse outcomes in heart failure (HF) patients. The impact of hyponatremia according to the ejection fraction (EF) is unclear. We evaluated the prognostic value of hyponatremia according to HF type. Methods and results The Korea Acute Heart Failure (KorAHF) registry consecutively enrolled 5625 patients. Hyponatremia was defined as serum sodium level < 135 mmol/L at hospital admission. HF with preserved and reduced ejection fraction were defined as an LVEF ≥ 50% and LVEF ≤ 40%, respectively. Among 5103 patients with available EF, 2088 (60%) had HFrEF, and 1284 (25%) had HFpEF. There was no difference in serum sodium level between the groups (HFrEF: 137.4 ± 4.7 mmol/L vs. HFpEF: 137.5 ± 5.0 mmol/L, P = 0.710). Hyponatremic patients had higher in-hospital mortality or urgent heart transplantation in all (11.3% vs. 4.5%, P < 0.001), in HFrEF (13.1% vs. 4.9%, P < 0.001), and in HFpEF (6.0% vs. 1.9%, P < 0.001). After adjustment for significant covariates, hyponatremia was associated with 1.5 fold increased risk for 1-year post-discharge death in the HFrEF group (HR, 1.52; 95% CI, 1.24–1.86), but not in the HFpEF group (HR, 1.16; 95% CI, 0.84–1.61). During admission, the sodium status changed in 22% of the patients and the discharge sodium status had greater prognostic value. Conclusions Hyponatremia is independent of HF type. Hyponatremia is a significant risk factor for adverse in-hospital outcomes; however its long-term prognostic value is only limited to patients with HFrEF, but not for those with HFpEF.

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U2 - 10.1016/j.ijcard.2017.08.004

DO - 10.1016/j.ijcard.2017.08.004

M3 - Article

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VL - 248

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EP - 245

JO - International Journal of Cardiology

JF - International Journal of Cardiology

SN - 0167-5273

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