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

https://doi.org/10.1016/j.amjmed.2009.04.025Get rights and content

Abstract

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.

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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    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.

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