Clinical research studyRecommendation of Low-Salt Diet and Short-term Outcomes in Heart Failure with Preserved Systolic Function
Section snippets
Overview of GAP-HF
The Mid-Michigan Guidelines Applied in Practice - Heart Failure (GAP-HF) study was a collaborative effort between the Greater Flint Health Coalition, the Michigan Peer Review Organization (affiliated with the Centers for Medicare and Medicaid Services), and the Michigan Chapter of the ACC to increase adherence to inpatient heart failure performance measures.3, 15 A prespecified secondary aim was to investigate the effects of hospital discharge recommendations, including sodium-restricted diet,
Study Population
A total of 2153 patients with ejection fraction assessment were discharged home from their index admission. After exclusion of subjects with known valvular disease or ejection fraction between 40% and 49% (n = 453), 724 had heart failure with preserved systolic function and 976 had systolic heart failure. We compared discharge recommendation documentation between these groups. In the prespecified follow-up cohort (see “Overview of GAP-HF” above and Figure 1), we analyzed 443 preserved systolic
Discussion
Over one fifth of patients hospitalized for decompensated heart failure with preserved systolic function die or are readmitted within 30 days of discharge. Our study demonstrates a discrepancy of care between systolic heart failure and heart failure with preserved systolic function that could potentially affect these short-term outcomes. We noted that heart failure patients with preserved systolic function had poorer chart documentation of guideline-based discharge recommendations than patients
Conclusions
Appropriate guideline-based discharge recommendations are frequently not provided to community hospital heart failure inpatients, particularly those with preserved systolic function. In selected heart failure patients with preserved systolic function, a documented discharge recommendation for sodium-restricted diet may be associated with lower 30-day death and hospital readmission rate. Prospective studies are needed to account for specific formats of discharge education and aspects of
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Cited by (40)
Implementation of a Multidisciplinary Inpatient Cardiology Service to Improve Heart Failure Outcomes in Guyana
2018, Journal of Cardiac FailureCitation Excerpt :This program was created with the goal of improving cardiovascular outcomes through systematic implementation of evidence-based cardiac interventions with emphasis on sustainability and effective resource utilization. Despite evidence supporting the value of multidisciplinary cardiovascular care services for improving clinical outcomes,7–13 the impact in developing countries has not been well studied. The objective of the present study was to determine the effectiveness of a dedicated inpatient cardiac care program in a resource-poor setting for improving practitioner adherence to guideline-directed HF medical therapy (GDMT) and reducing hospital length of stay, readmission rates, and mortality.
Dietary Sodium Interventions to Prevent Hospitalization and Readmission in Adults with Congestive Heart Failure
2018, American Journal of MedicineCitation Excerpt :The World Health Organization recommends a reduction to <2 g/d sodium (5 g/d salt) in adults (strong recommendation). Our comprehensive search in PubMed, EMBASE, the Cochrane Library, and clinicaltrials.gov identified 1 systematic review, 11 randomized controlled trials, and 2 observational studies that examined the benefits and harms of restricted dietary salt in adults with heart failure.13-25 Primary randomized studies compared lower dietary salt intake (80 mmol/d) with moderate salt intake (120 mmol/d) or usual care without enforced recommendations to reduce dietary salt.
Dietary sodium restriction in heart failure: A recommendation worth its salt?
2016, JACC: Heart FailureEvaluating the safety and efficacy of sodium-restricted/Dietary Approaches to Stop Hypertension diet after acute decompensated heart failure hospitalization: Design and rationale for the Geriatric out of hospital Randomized MEal Trial in Heart Failure (GOURMET-HF)
2015, American Heart JournalCitation Excerpt :Other recent trials of telemedicine,7 diuretics,8 and newer pharmacologic agents9 have been disappointing, suggesting that outcomes in ADHF patients are driven by mechanisms not addressed by current approaches. Dietary sodium restriction is associated with reduced risk for ADHF in observational studies10 and has been described as a “cornerstone of HF disease management.”11 However, several randomized studies suggest that this strategy may be ineffective or even harmful in recently discharged ADHF patients.12
Funding: Greater Flint Health Coalition, AstraZeneca Pharmaceuticals, Pfizer, Inc., GlaxoSmithKline, Blue Cross Blue Shield of Michigan Foundation (all unrestricted grants). Dr. Hummel is supported by a National Institutes of Health T-32 research training grant, 5T32HL007853-10.
Conflict of Interest: Dr. DeFranco has previously served as a consultant to AstraZeneca Pharmaceuticals and Pfizer, Inc. There are no other conflicts of interest to report.
Authorship: All authors had access to the data and contributed significantly to the final manuscript.