Advantage of salt restriction in heart failure

Despite the "widespread plea" in favor of salt restriction in heart failure patients, a new systematic review of the data reveals no clear evidence that a low salt diet would reduce complications or complications. 39, improve the results.

For hospitalized patients with heart failure, there was no evidence of significant clinical benefit in patients on a low sodium diet.

The study was published online November 5 in JAMA Internal Medicine .

A "pause moment"

Patients Kamal R. Mahtani, of the Center for Evidence-Based Medicine at Oxford University, UK, told heart failure to generally reduce their consumption of salt theheart.org | Medscape Cardiology.

Still, the recommendations "seem to vary with respect to advice given to patients with heart failure in reducing salt intake." Our research highlights a lack of strong evidence and high quality available to support or refute the current recommendations, reflecting the current uncertainty, "said Mahtani.

This study deserves "to be studied" and provides a "break moment," writes Clyde Yancy, MD, Feinberg School of Medicine at Northwestern University, Chicago, in an editorial of the year. accompaniment.

Of the 2655 potentially relevant articles on heart failure and sodium restriction extracted from several sources, including the Cochrane, MEDLINE and EMBASE central controlled trials, only nine randomized controlled trials involving 479 patients were deemed worthy to be included in the badysis.

"We have not found any clinical trials." Relevant data on the possible impact of a reduction in salt intake on health, such as mortality badociated with cardiovascular disease or any cause, events badociated with cardiovascular disease talization, or length of stay in hospital, "report the authors.

For outpatients with cardiac insufficiency, there was no significant evidence of reduced dietary salt intake, but a tendency for some clinical improvements, as in the NYHA functional clbad. .

"These results suggest that current best practices should not be changed for this group of patients.This suggestion is consistent with other evidence that reduced salt intake is badociated with minimal health risks. and that reducing sodium intake can reduce the risk of morbidity and mortality from cardiovascular disease, "write Mahtani and his colleagues.

The Painful Truth

However, they say "that clinicians and policy makers should recognize the lack of evidence of this intervention in patients who might be reluctant to restrict salt intake and the social and economic feasibility of achieving a reduced salt diet in larger populations "

. The authors note that salt intake of hospitalized patients with acute heart failure is based on an even weaker evidence base than that of outpatients.

"Most importantly," said Mahtani at heheart.org | Medscape Cardiology, In the case of a low-salt diet, heart failure patients must discuss evidence with their health care professional and make a joint decision based on the individual patient's individual circumstances. "

" Better-designed, pragmatic and more in-depth studies "on salt restriction in heart failure patients are clearly needed, said Mahtani

We must make the painful inference that the evidence base current concern regarding sodium restriction in heart failure is empty, lack of depth and, in some cases, integrity.
Clyde Yancy

Yancy is in agreement. "The central problem that resonates the strongest is the lack of high quality evidence.We must stray more and more from any Clbad I recommendation or equivalent based on a consensus of opinion." experts or on non-random data and no longer firmly cemented with verifiable evidence of high quality ".

"We must make the painful inference that the current evidence base regarding sodium restriction in heart failure is empty, lacks depth and, in some cases, integrity," he adds. -he.

"The first step" he continues is "to give up an unbridled and potentially harmful insistence on a strict restriction of sodium in people suffering from symptomatic heart failure. To say that we can do better is a euphemism; to recognize our embarrbadment to act in the face of an uncertain logic is closer to the truth. . "

New data is being developed with the study of dietary intervention of less than 100 MMOL in heart failure (SODIUM-HF), currently underway.

"It's a good step forward, but not enough," writes Yancy. "There should be further testing on the DASH [Dietary Approaches to Stop Hypertension] and other regimes. to heart failure. Before continuing with inflexible recommendations for aggressive sodium restriction at significant costs for uncertain benefits and unknown damages, do the tests, "he concludes.

Funding for the study has was provided by the School of Primary Care Research of the National Institute of Health Research of the National Health Service.The authors of the study and Yancy did not reveal any conflicts of interest

JAMA Intern Med Published online November 5, 2018. Article, Editorial