Characterization and prognostic value of persistent hyponatremia in patients with severe heart failure in the ESCAPE trial

Mihai Gheorghiade, Joseph S. Rossi, William Cotts, David D. Shin, Anne S. Hellkamp, Ileana L. Pina, Gregg C. Fonarow, Teresa DeMarco, Daniel F. Pauly, Joseph Rogers, Thomas G. DiSalvo, Javed Butler, Joshua M. Hare, Gary S. Francis, Wendy Gattis Stough, Christopher M. O'Connor

Research output: Contribution to journalArticle

234 Citations (Scopus)

Abstract

Background: Mild hyponatremia is relatively common in patients hospitalized with heart failure (HF). To our knowledge, the association of hyponatremia with outcomes has not been evaluated in the context of in-hospital clinical course including central hemodynamics and changes in serum sodium level. Methods: The ESCAPE trial (Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness) was a randomized, controlled study designed to evaluate the utility of a pulmonary artery catheter plus clinical assessment vs clinical assessment alone in guiding therapy in patients hospitalized with New York Heart Association class IV HF due to systolic dysfunction (left ventricular ejection fraction <30%). A Cox proportional hazards model with baseline serum sodium level as a continuous variable was used to examine the association of serum sodium level with 6-month postdischarge mortality, HF rehospitalization, and death or rehospitalization. A categorical analysis was also performed comparing persistent and corrected hyponatremia. Results: A total of 433 hospitalized patients with HF were enrolled in ESCAPE. Hyponatremia (serum sodium level ≤134 mEq/L) was present in 103 patients (23.8%). (To convert serum sodium to millimoles per liter, multiply by 1.0.) Of these, 71 had persistent hyponatremia (68.9%). Hyponatremia was associated with higher 6-month mortality after covariate adjustment (hazard ratio [HR] for each 3-mEq/L decrease in sodium level, 1.23; 95% confidence interval [CI], 1.05-1.43) (P=.01). After controlling for baseline variables and clinical response, we found that patients with persistent hyponatremia had an increased risk of all-cause mortality (31% vs 16%; HR, 1.82) (P=.04), HF rehospitalization (62% vs 43%; HR, 1.52) (P=.03), and death or rehospitalization (73% vs 50%; HR, 1.54) (P=.01) compared with normonatremic patients. Conclusion: Persistent hyponatremia was an independent predictor of mortality, HF hospitalization, and death or rehospitalization despite clinical and hemodynamic improvements that were similar to those in patients without hyponatremia.

Original languageEnglish (US)
Pages (from-to)1998-2005
Number of pages8
JournalArchives of Internal Medicine
Volume167
Issue number18
DOIs
StatePublished - Oct 8 2007
Externally publishedYes

Fingerprint

Hyponatremia
Heart Failure
Sodium
Serum
Mortality
Hemodynamics
Swan-Ganz Catheterization
Proportional Hazards Models
Stroke Volume
Pulmonary Artery
Hospitalization
Catheters
Confidence Intervals

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Characterization and prognostic value of persistent hyponatremia in patients with severe heart failure in the ESCAPE trial. / Gheorghiade, Mihai; Rossi, Joseph S.; Cotts, William; Shin, David D.; Hellkamp, Anne S.; Pina, Ileana L.; Fonarow, Gregg C.; DeMarco, Teresa; Pauly, Daniel F.; Rogers, Joseph; DiSalvo, Thomas G.; Butler, Javed; Hare, Joshua M.; Francis, Gary S.; Stough, Wendy Gattis; O'Connor, Christopher M.

In: Archives of Internal Medicine, Vol. 167, No. 18, 08.10.2007, p. 1998-2005.

Research output: Contribution to journalArticle

Gheorghiade, M, Rossi, JS, Cotts, W, Shin, DD, Hellkamp, AS, Pina, IL, Fonarow, GC, DeMarco, T, Pauly, DF, Rogers, J, DiSalvo, TG, Butler, J, Hare, JM, Francis, GS, Stough, WG & O'Connor, CM 2007, 'Characterization and prognostic value of persistent hyponatremia in patients with severe heart failure in the ESCAPE trial', Archives of Internal Medicine, vol. 167, no. 18, pp. 1998-2005. https://doi.org/10.1001/archinte.167.18.1998
Gheorghiade, Mihai ; Rossi, Joseph S. ; Cotts, William ; Shin, David D. ; Hellkamp, Anne S. ; Pina, Ileana L. ; Fonarow, Gregg C. ; DeMarco, Teresa ; Pauly, Daniel F. ; Rogers, Joseph ; DiSalvo, Thomas G. ; Butler, Javed ; Hare, Joshua M. ; Francis, Gary S. ; Stough, Wendy Gattis ; O'Connor, Christopher M. / Characterization and prognostic value of persistent hyponatremia in patients with severe heart failure in the ESCAPE trial. In: Archives of Internal Medicine. 2007 ; Vol. 167, No. 18. pp. 1998-2005.
@article{72430d7006ef4009812b46ceee9039db,
title = "Characterization and prognostic value of persistent hyponatremia in patients with severe heart failure in the ESCAPE trial",
abstract = "Background: Mild hyponatremia is relatively common in patients hospitalized with heart failure (HF). To our knowledge, the association of hyponatremia with outcomes has not been evaluated in the context of in-hospital clinical course including central hemodynamics and changes in serum sodium level. Methods: The ESCAPE trial (Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness) was a randomized, controlled study designed to evaluate the utility of a pulmonary artery catheter plus clinical assessment vs clinical assessment alone in guiding therapy in patients hospitalized with New York Heart Association class IV HF due to systolic dysfunction (left ventricular ejection fraction <30{\%}). A Cox proportional hazards model with baseline serum sodium level as a continuous variable was used to examine the association of serum sodium level with 6-month postdischarge mortality, HF rehospitalization, and death or rehospitalization. A categorical analysis was also performed comparing persistent and corrected hyponatremia. Results: A total of 433 hospitalized patients with HF were enrolled in ESCAPE. Hyponatremia (serum sodium level ≤134 mEq/L) was present in 103 patients (23.8{\%}). (To convert serum sodium to millimoles per liter, multiply by 1.0.) Of these, 71 had persistent hyponatremia (68.9{\%}). Hyponatremia was associated with higher 6-month mortality after covariate adjustment (hazard ratio [HR] for each 3-mEq/L decrease in sodium level, 1.23; 95{\%} confidence interval [CI], 1.05-1.43) (P=.01). After controlling for baseline variables and clinical response, we found that patients with persistent hyponatremia had an increased risk of all-cause mortality (31{\%} vs 16{\%}; HR, 1.82) (P=.04), HF rehospitalization (62{\%} vs 43{\%}; HR, 1.52) (P=.03), and death or rehospitalization (73{\%} vs 50{\%}; HR, 1.54) (P=.01) compared with normonatremic patients. Conclusion: Persistent hyponatremia was an independent predictor of mortality, HF hospitalization, and death or rehospitalization despite clinical and hemodynamic improvements that were similar to those in patients without hyponatremia.",
author = "Mihai Gheorghiade and Rossi, {Joseph S.} and William Cotts and Shin, {David D.} and Hellkamp, {Anne S.} and Pina, {Ileana L.} and Fonarow, {Gregg C.} and Teresa DeMarco and Pauly, {Daniel F.} and Joseph Rogers and DiSalvo, {Thomas G.} and Javed Butler and Hare, {Joshua M.} and Francis, {Gary S.} and Stough, {Wendy Gattis} and O'Connor, {Christopher M.}",
year = "2007",
month = "10",
day = "8",
doi = "10.1001/archinte.167.18.1998",
language = "English (US)",
volume = "167",
pages = "1998--2005",
journal = "JAMA Internal Medicine",
issn = "2168-6106",
publisher = "American Medical Association",
number = "18",

}

TY - JOUR

T1 - Characterization and prognostic value of persistent hyponatremia in patients with severe heart failure in the ESCAPE trial

AU - Gheorghiade, Mihai

AU - Rossi, Joseph S.

AU - Cotts, William

AU - Shin, David D.

AU - Hellkamp, Anne S.

AU - Pina, Ileana L.

AU - Fonarow, Gregg C.

AU - DeMarco, Teresa

AU - Pauly, Daniel F.

AU - Rogers, Joseph

AU - DiSalvo, Thomas G.

AU - Butler, Javed

AU - Hare, Joshua M.

AU - Francis, Gary S.

AU - Stough, Wendy Gattis

AU - O'Connor, Christopher M.

PY - 2007/10/8

Y1 - 2007/10/8

N2 - Background: Mild hyponatremia is relatively common in patients hospitalized with heart failure (HF). To our knowledge, the association of hyponatremia with outcomes has not been evaluated in the context of in-hospital clinical course including central hemodynamics and changes in serum sodium level. Methods: The ESCAPE trial (Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness) was a randomized, controlled study designed to evaluate the utility of a pulmonary artery catheter plus clinical assessment vs clinical assessment alone in guiding therapy in patients hospitalized with New York Heart Association class IV HF due to systolic dysfunction (left ventricular ejection fraction <30%). A Cox proportional hazards model with baseline serum sodium level as a continuous variable was used to examine the association of serum sodium level with 6-month postdischarge mortality, HF rehospitalization, and death or rehospitalization. A categorical analysis was also performed comparing persistent and corrected hyponatremia. Results: A total of 433 hospitalized patients with HF were enrolled in ESCAPE. Hyponatremia (serum sodium level ≤134 mEq/L) was present in 103 patients (23.8%). (To convert serum sodium to millimoles per liter, multiply by 1.0.) Of these, 71 had persistent hyponatremia (68.9%). Hyponatremia was associated with higher 6-month mortality after covariate adjustment (hazard ratio [HR] for each 3-mEq/L decrease in sodium level, 1.23; 95% confidence interval [CI], 1.05-1.43) (P=.01). After controlling for baseline variables and clinical response, we found that patients with persistent hyponatremia had an increased risk of all-cause mortality (31% vs 16%; HR, 1.82) (P=.04), HF rehospitalization (62% vs 43%; HR, 1.52) (P=.03), and death or rehospitalization (73% vs 50%; HR, 1.54) (P=.01) compared with normonatremic patients. Conclusion: Persistent hyponatremia was an independent predictor of mortality, HF hospitalization, and death or rehospitalization despite clinical and hemodynamic improvements that were similar to those in patients without hyponatremia.

AB - Background: Mild hyponatremia is relatively common in patients hospitalized with heart failure (HF). To our knowledge, the association of hyponatremia with outcomes has not been evaluated in the context of in-hospital clinical course including central hemodynamics and changes in serum sodium level. Methods: The ESCAPE trial (Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness) was a randomized, controlled study designed to evaluate the utility of a pulmonary artery catheter plus clinical assessment vs clinical assessment alone in guiding therapy in patients hospitalized with New York Heart Association class IV HF due to systolic dysfunction (left ventricular ejection fraction <30%). A Cox proportional hazards model with baseline serum sodium level as a continuous variable was used to examine the association of serum sodium level with 6-month postdischarge mortality, HF rehospitalization, and death or rehospitalization. A categorical analysis was also performed comparing persistent and corrected hyponatremia. Results: A total of 433 hospitalized patients with HF were enrolled in ESCAPE. Hyponatremia (serum sodium level ≤134 mEq/L) was present in 103 patients (23.8%). (To convert serum sodium to millimoles per liter, multiply by 1.0.) Of these, 71 had persistent hyponatremia (68.9%). Hyponatremia was associated with higher 6-month mortality after covariate adjustment (hazard ratio [HR] for each 3-mEq/L decrease in sodium level, 1.23; 95% confidence interval [CI], 1.05-1.43) (P=.01). After controlling for baseline variables and clinical response, we found that patients with persistent hyponatremia had an increased risk of all-cause mortality (31% vs 16%; HR, 1.82) (P=.04), HF rehospitalization (62% vs 43%; HR, 1.52) (P=.03), and death or rehospitalization (73% vs 50%; HR, 1.54) (P=.01) compared with normonatremic patients. Conclusion: Persistent hyponatremia was an independent predictor of mortality, HF hospitalization, and death or rehospitalization despite clinical and hemodynamic improvements that were similar to those in patients without hyponatremia.

UR - http://www.scopus.com/inward/record.url?scp=35348978348&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=35348978348&partnerID=8YFLogxK

U2 - 10.1001/archinte.167.18.1998

DO - 10.1001/archinte.167.18.1998

M3 - Article

VL - 167

SP - 1998

EP - 2005

JO - JAMA Internal Medicine

JF - JAMA Internal Medicine

SN - 2168-6106

IS - 18

ER -