Impact of Sodium on Length of Stay in Patients with HF
Study Objective. To investigate the sources and quantities of nondietary sodium administration in patients hospitalized for acute heart failure exacerbation, and to evaluate the impact of sodium administration on length of stay.
Design. Retrospective analysis.
Setting. University-affiliated medical center.
Patients. One hundred and eighty-two consecutive patients admitted to a cardiac intensive care unit for acute heart failure exacerbation between January 1 and June 30, 2009.
Measurements and Main Results. Drug therapy profiles of all patients were reviewed for sources and quantities of nondietary sodium administration, and the impact of sodium administration on hospital stay was analyzed. The mean ± SD nondietary sodium load was 4.0 ± 5.0 g/day. The predominant sources of sodium were intravenous 0.9% or 0.45% sodium chloride. The daily amount of sodium administration was directly related to the duration of hospital stay, with an average sodium load of 1.2 g/day correlating with hospital stays of up to 5 days, and an average of 2.6 g/day correlating with hospital stays of up to 10 days.
Conclusion. We observed excessive sodium administration in patients hospitalized for acute exacerbation of heart failure. We speculate that reducing sodium administration in these patents may reduce length of hospital stay and cost of hospitalization.
In individuals older than 65 years, the incidence of heart failure approaches 10/1000 population. The disease affects 5 million Americans, with an annual incidence of half a million. The estimated direct and indirect costs of heart failure in the United States for 2010 will total $39.2 billion. Seventy percent of this expenditure is due to heart failure admissions. Between 1990 and 1999, the annual number of heart failure hospitalizations increased from 2.4 to 3.6 million. Hospital discharges for heart failure increased from 877,000 in 1996 to 1,106,000 in 2006.
Sodium restriction is recommended for patients with the clinical syndrome of heart failure. For most hospitalized patients, a lowsodium diet is recommended; in patients with recurrent or refractory volume overload, even stricter sodium restriction should be considered. According to the most current guidelines for treatment of patients with heart failure, restriction of dietary sodium to 2–3 g/day is recommended for patients with the clinical syndrome of heart failure, with a further restriction to less than 2 g/day in moderate-to-severe heart failure. However, the guidelines do not address nondietary sodium administration.
Based on our empiric clinical observation that the administration of sodium chloride as a vehicle for drug administration is common in patients admitted to the cardiac intensive care unit with heart failure exacerbation, we sought to investigate the sources and quantities of nondietary sodium administration in these patients, and to evaluate the impact of sodium administration on length of stay.
Abstract and Introduction
Abstract
Study Objective. To investigate the sources and quantities of nondietary sodium administration in patients hospitalized for acute heart failure exacerbation, and to evaluate the impact of sodium administration on length of stay.
Design. Retrospective analysis.
Setting. University-affiliated medical center.
Patients. One hundred and eighty-two consecutive patients admitted to a cardiac intensive care unit for acute heart failure exacerbation between January 1 and June 30, 2009.
Measurements and Main Results. Drug therapy profiles of all patients were reviewed for sources and quantities of nondietary sodium administration, and the impact of sodium administration on hospital stay was analyzed. The mean ± SD nondietary sodium load was 4.0 ± 5.0 g/day. The predominant sources of sodium were intravenous 0.9% or 0.45% sodium chloride. The daily amount of sodium administration was directly related to the duration of hospital stay, with an average sodium load of 1.2 g/day correlating with hospital stays of up to 5 days, and an average of 2.6 g/day correlating with hospital stays of up to 10 days.
Conclusion. We observed excessive sodium administration in patients hospitalized for acute exacerbation of heart failure. We speculate that reducing sodium administration in these patents may reduce length of hospital stay and cost of hospitalization.
Introduction
In individuals older than 65 years, the incidence of heart failure approaches 10/1000 population. The disease affects 5 million Americans, with an annual incidence of half a million. The estimated direct and indirect costs of heart failure in the United States for 2010 will total $39.2 billion. Seventy percent of this expenditure is due to heart failure admissions. Between 1990 and 1999, the annual number of heart failure hospitalizations increased from 2.4 to 3.6 million. Hospital discharges for heart failure increased from 877,000 in 1996 to 1,106,000 in 2006.
Sodium restriction is recommended for patients with the clinical syndrome of heart failure. For most hospitalized patients, a lowsodium diet is recommended; in patients with recurrent or refractory volume overload, even stricter sodium restriction should be considered. According to the most current guidelines for treatment of patients with heart failure, restriction of dietary sodium to 2–3 g/day is recommended for patients with the clinical syndrome of heart failure, with a further restriction to less than 2 g/day in moderate-to-severe heart failure. However, the guidelines do not address nondietary sodium administration.
Based on our empiric clinical observation that the administration of sodium chloride as a vehicle for drug administration is common in patients admitted to the cardiac intensive care unit with heart failure exacerbation, we sought to investigate the sources and quantities of nondietary sodium administration in these patients, and to evaluate the impact of sodium administration on length of stay.
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