Prognostic impact of hyponatraemia and hypernatraemia at admission and discharge in heart failure patients with preserved, mid‐range and reduced ejection fraction

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Abstract
Background: Hyponatraemia is common in patients with acute heart failure (HF). Aims: To determine the impact of sodium disturbances on mortality and readmissions in HF with reduced left ventricular ejection fraction (HFrEF), preserved ejection fraction (HFpEF) and mid‐range ejection fraction (HFmrEF).Methods: This study was a prospective multicentre consecutive registry in 20 hospitals, including patients admitted due to acute HF in cardiology departments. Sodium 145 mmol/L hypernatraemia and 135–145 mmol/L normal.Results: A total of 1309 patients was included. Mean age was 72.0 ± 11.9 years, and 810 (61.9%) were male. Mean serum sodium level was 138.6 ± 4.7 mmol/L at hospital admission and 138.1 ± 4.1 mmol/L at discharge. The evolution of sodium levels was: normal‐at‐admission/normal‐at‐discharge 941 (71.9%), abnormal‐at‐admission/normal‐at‐discharge 127 (9.7%), normal‐at‐admission/abnormal‐at‐discharge 155 (11.8%) and abnormal‐at‐admission/abnormal‐at‐discharge 86 (6.6%). Hyponatraemia at discharge was more common in HFrEF (109 (20.7%)) than in HFpEF (79 (13.9%)) and HFmrEF (27 (12%)), P = 0.003. The prevalence of hypernatraemia at discharge was similar in the three groups: HFrEF (10 (1.9%)), HFpEF (12 (2.1%)) and HFmrEF (4 (1.9%)), P = 0.96. In multivariate analysis, abnormal sodium concentrations at hospital admission (hazard ratio (HR) 1.42, 95% confidence interval (CI) 1.15–1.76, P = 0.001) and discharge (HR 1.33, 95% CI 1.08–1.64, P = 0.007) were both independently associated with increased mortality and readmissions at 12 months.Conclusions: Hyponatraemia and hypernatraemia at admission and discharge predict a poor outcome in patients with acute HF regardless of left ventricular ejection fraction. Hyponatraemia at discharge is more frequent in HFrEF than in the other groups.

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