Prognostic value of hyponatremia in heart failure patients: an analysis of the Clinical Characteristics and Outcomes in the Relation with Serum Sodium Level in Asian Patients Hospitalized for Heart Failure (COAST) study.
10.3904/kjim.2015.30.4.460
- Author:
Byung Su YOO
1
;
Jin Joo PARK
;
Dong Ju CHOI
;
Seok Min KANG
;
Juey Jen HWANG
;
Shing Jong LIN
;
Ming Shien WEN
;
Jian ZHANG
;
Junbo GE
Author Information
1. Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea.
- Publication Type:Original Article ; Comparative Study ; Multicenter Study
- Keywords:
Hyponatremia;
Predictor of clinical outcomes;
Hospitalized heart failure;
East Asians
- MeSH:
Aged;
Aged, 80 and over;
Asia/epidemiology;
*Asian Continental Ancestry Group;
Biomarkers/blood;
Cardiovascular Agents/therapeutic use;
Disease-Free Survival;
Female;
Guideline Adherence;
Healthcare Disparities;
Heart Failure/*diagnosis/drug therapy/ethnology/mortality/physiopathology;
*Hospitalization;
Humans;
Hyponatremia/blood/*diagnosis/drug therapy/ethnology/mortality;
Male;
Middle Aged;
Practice Guidelines as Topic;
Predictive Value of Tests;
Proportional Hazards Models;
Risk Factors;
Sodium/*blood;
Stroke Volume;
Time Factors;
Treatment Outcome
- From:The Korean Journal of Internal Medicine
2015;30(4):460-470
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND/AIMS: Hyponatremia is a well-known risk factor for poor outcomes in Western studies of heart failure (HF) patients. We evaluated the predictive value of hyponatremia in hospitalized Asian HF patients. METHODS: The Clinical Characteristics and Outcomes in the Relation with Serum Sodium Level in Asian Patients Hospitalized for Heart Failure (the COAST) study enrolled hospitalized patients with systolic HF (ejection fraction < 45%) at eight centers in South Korea, Taiwan, and China. The relationship between admission sodium level and clinical outcomes was analyzed in 1,470 patients. RESULTS: The mean admission sodium level was 138 +/- 4.7 mmol/L, and 247 patients (16.8%) had hyponatremia defined as Na+ < 135 mmol/L. The 12-month mortality was higher in hyponatremic patients (27.9% vs. 14.6%, p < 0.001), and hyponatremia was an independent predictor of 12-month mortality (hazard ratio, 1.72; 95% confidence interval, 1.12 to 2.65). During hospital admission, 57% of hyponatremic patients showed improvement without improvement in their clinical outcomes (p = 0.620). The proportion of patients with optimal medical treatment was only 26.5% and 44.2% at admission and discharge, respectively, defined as the combined use of angiotensin-converting-enzyme inhibitor/angiotensin receptor blocker and beta-blocker. Underuse of optimal medical treatment was more pronounced in hyponatremic patients. CONCLUSIONS: In hospitalized Asian HF patients, hyponatremia at admission is common and is an independent predictor of poor clinical outcome. Furthermore, hyponatremic patients receive less optimal medical treatment than their counterparts.
