(P118) SODIUM RESTRICTION IN PATIENTS WITH HEART FAILURE:A SYSTEMATIC REVIEW AND META-ANALYSIS OFRANDOMIZED CLINICAL TRIALS

Background: Sodium restriction is a non-pharmacologic treatment suggested by guidelines for the management of patients with heart failure (HF). In this study, we synthesized the data from the randomized controlled trials (RCT) on the effects of sodium restriction on clinical outcomes in patients with HF.

METHODS AND RESULTS: In this aggregate data meta-analysis, Cochrane Central, MEDLINE, Embase Ovid, and CINAHL Plus databases were searched up to March 31st, 2022. RCTs were included if they investigated the effects of sodium/salt restriction as compared to no restriction on clinical outcomes in patients with HF. Outcomes of interest included mortality, hospitalization, change in NYHA functional class and quality of life (QoL). Seventeen RCTs were identified with a pooled cohort of 1683 participants (834 and 871 patients in intervention and control groups, respectively). Sodium restriction did not reduce the risk of all-cause death (odds ratio (OR), 0.95 (95% confidence interval (CI) 0.58 to 1.58)), hospitalization (OR, 0.84 (95%CI 0.62 to 1.13)) or composite of death/rehospitalization (OR, 0.88 (95%CI 0.63 to 1.23)) (Figure). The results remained similar in different subgroups. There was a numerically reduced risk of death reported with sodium restriction in RCTs with sodium restriction ≥ 2000 as opposed to < 2000 mg/day and in RCTs with versus without fluid restriction as a co-intervention. Among RCTs reporting the NYHA change, 2 RCTs which accounted for 2/3rd of the pooled cohort showed improvement in NYHA class with sodium restriction. Six RCTs showed improvement or trends for improvement of QoL measures with sodium restriction, and four RCTs showed no benefit of sodium restriction on QoL.

Conclusion: In a meta-analysis of RCTs, sodium restriction did not reduce clinical outcomes such as all-cause mortality, or hospitalization in patients with HF. Despite the lack of definitive data, sodium restriction might be associated with improvements in symptoms or quality of life.