Abstract 12930: Low Urine Sodium (UNa) Early After Heart Failure Admission Predicts Long Length of Stay and Early Mortality
Background: Although decongestion is the primary focus of acute heart failure (HF) management, the degree of natriuretic response to diuretic therapy varies and may predict length of stay (LOS) and early outcomes. We hypothesize that a UNa <60 mmol/L, measured after initial intravenous (IV) diuretic administration, would be associated with longer duration of IV diuretic, longer LOS, increased use of inotropic therapy in hospital and higher risk of death.
Methods and Results: From July 1, 2014-May 30, 2015, we enrolled 100 unique patients hospitalized to the advanced HF service for decompensated HF. Dose of IV diuretic was based on their daily oral home dose. Spot urine samples were collected within a median of 98 (0-187) minutes after initial diuretic therapy. Patients with UNa <60 mmol/L (n=30) had significantly lower serum sodium and higher admission NT-proBNP than those with UNa >60 mmol/L (n=70). As well, they were more commonly rated with hemodynamic profile C (“cold and wet”, 40.0 vs.11.4%, p=0.002) and INTERMACS profile 3-4 (30.0 vs. 12.9%, p= 0.04). During the hospital stay, patients with low initial UNa required longer use of IV diuretic therapy (9.5 vs. 5.0 days, p<0.0001) and had a longer median LOS (12.0 vs. 6.0 days, p< 0.0001) than those with high UNa. After adjusting for eGFR, UNa <60 mmol/L was still associated with a higher likelihood of inotropic usage in hospital (hazard ratio [HR] 9.91 (3.27-30.05); p<0.0001) and death (HR 3.14 (1.20-8.23); p=0.004) at a median follow-up period of 85 (38-159) days (figure 1).
Conclusions: Low UNa after initial IV diuretic administration identifies a population of acute HF patients with advanced disease who have longer LOS and are at high risk for death. Measurement of UNa after first diuretic therapy may help to facilitate triage of patients with heart failure and anticipate the need for advanced HF therapies
Author Disclosures: A. Luk: None. J.D. Groarke: None. D.M. Gopal: None. E. Joyce: None. S.P. Shah: None. A. Desai: Research Grant; Modest; Novartis, Celladon. Consultant/Advisory Board; Modest; St. Jude, Relypsa, Merck. N. Lakdawala: None. L. Stevenson: None.
- © 2015 by American Heart Association, Inc.