Abstract 10164: Dietary Sodium Compliance in Heart Failure Patients is Poor Despite Extensive Education and Follow-up
Background: Major societies have guidelines on dietary sodium restriction in patients with heart failure (HF). Data on adherence to these guidelines have a number of limitations. We hypothesized that even well instructed HF patients are poorly adherent and tested this using rigorous methodology.
Study Design/Methods: We evaluated 305 outpatients with HF diagnosed for at least three months who received formalized dietary education on sodium restriction. Dietary sodium consumption and adherence to <3 gram, < 2 gram, and <1.5 gram dietary guidelines were estimated by 24-hour urinary sodium excretion. 24-hour urinary creatinine excretion was measured and compared to published ranges based on age, sex, race, and weight. Most patients (n=261) provided two urine samples.
Results: 305 patients provided one sample with a mean 24-hour urine sodium excretion of 3.15 +/- 1.6 grams. This high mean excretion was confirmed (3.12 +/- 1.4 grams) when averaging two samples from 261 patients. 166 patients had 24-hour urine creatinine excretion rates that were within reference range for healthy adults; they also had high sodium excretion with an average of 3.19 +/- 1.2 grams. % Adherence to dietary guidelines was poor overall (figure). The number of patients adherent to the < 1.5 gram or < 2 gram recommendations was fewer when analyzing the creatinine-referenced samples compared to the initial 305 samples (5% versus 15%, p = 0.002 & 14% versus 23%, p=0.023, respectively). There were no correlations between demographic variables and 24-hour sodium excretion with the exception that women excreted less than men: 2.6 +/- 1.3 grams versus 3.5 +/- 1.6 grams, p<0.001.
Conclusions: In this large population of chronic HF patients who were provided explicit dietary instruction, sodium consumption exceeds amounts recommended by multiple professional societies. The therapeutic implications and clinical consequences of this require further study.
- © 2013 by American Heart Association, Inc.