HF: Sodium and Fluid (2016)

Intervention
In patients with advanced heart failure (NYHA Class IV/AHA Stage D), what is the effect of sodium or fluid intake on quality measures (re-admissions rate, length of stay, mortality)?
- Conclusion
  In patients with advanced heart failure (NYHA Class IV/AHA Stage D), research reported an increased risk of death or deterioration associated with frequent consumption of salty foods or increased ratio of fluids to cardiac index. Research is needed regarding the effect of sodium or fluid intake on re-admissions rate and length of stay in patients with advanced heart failure.
- Grade: III
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: In patients with advanced heart failure (NYHA Class IV/AHA Stage D), what is the effect of sodium or fluid intake on quality measures (readmissions rate, length of stay, mortality)?
- Search Plan and Results: HF: Sodium and Fluid (2014)
In patients with advanced heart failure (NYHA Class IV/AHA Stage D), what is the effect of sodium or fluid intake on quality of life, signs and symptoms?
- Conclusion
  In patients with advanced heart failure (NYHA Class IV/AHA Stage D), research reported that patients who consumed salty foods more frequently were more likely to be symptomatic, as indicated by NYHA functional class IV. Research is needed regarding the effect of sodium or fluid intake on quality of life in patients with advanced heart failure.
- Grade: III
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: In patients with advanced heart failure (NYHA Class IV/AHA Stage D), what is the effect of sodium or fluid intake on quality of life, signs and symptoms?
- Search Plan and Results: HF: Sodium and Fluid (2014)
In patients with advanced heart failure (NYHA Class IV/AHA Stage D), what is the effect of sodium or fluid intake on renal function labs and clinical labs?
- Conclusion
  In patients with advanced heart failure (NYHA Class IV/AHA Stage D), research reported that hyponatremia (less than 130mg per dL) was associated with fluid intake of over two liters per day. Research is needed regarding the effect of sodium or fluid intake on BUN, creatinine and BNP in patients with advanced heart failure.
- Grade: III
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: In patients with advanced heart failure (NYHA Class IV/AHA Stage D), what is the effect of sodium or fluid intake on renal function labs and clinical labs?
- Search Plan and Results: HF: Sodium and Fluid (2014)
In patients with heart failure (NYHA Classes I-IV/AHA Stages B and C), what is the effect of sodium or fluid intake on renal function labs and clinical labs?
- Conclusion
  In patients with heart failure (NYHA Classes I-IV/AHA Stages B and C), research reported that among subjects receiving one liter of fluid per day, those consuming 2,800mg of sodium per day had significantly reduced BUN, creatinine and BNP levels than those consuming 1,800mg of sodium per day. In addition, subjects consuming 2,800mg of sodium per day had serum sodium levels that were increased and maintained within normal limits, whereas subjects consuming 1,800mg of sodium per day had a gradual reduction in serum sodium to below normal limits. Further research is needed regarding the effect of sodium or fluid intake on renal function and clinical labs.
- Grade: III
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: In patients with heart failure (NYHA Classes I–IV/AHA Stages B and C), what is the effect of sodium or fluid intake on renal function labs and clinical labs?
- Search Plan and Results: HF: Sodium and Fluid (2014)
In patients with heart failure (NYHA Classes I-IV/AHA Stages B and C), what is the effect of sodium or fluid intake on quality of life, signs and symptoms?
- Conclusion
  In patients with heart failure (NYHA Classes I-IV/AHA Stages B and C), research reported that among subjects receiving one liter of fluid per day, those consuming 2,800mg sodium per day had significant and sustained reductions in body weight and improvements in NYHA class, compared to those consuming 1,800mg sodium per day. In addition, research reported that sodium intake of less than 3,000mg per day resulted in reduced symptom burden (in terms of frequency and severity of shortness of breath, difficulty breathing when lying flat, swelling of legs or ankles, lack of energy and lack of appetite), when compared to sodium intake levels above 3,000mg per day, but fluid intake was not reported. Further research is needed regarding the effect of sodium or fluid intake on quality of life, signs and symptoms.
- Grade: III
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: In patients with heart failure (NYHA Classes I–IV/AHA Stages B and C), what is the effect of sodium or fluid intake on quality of life, signs and symptoms?
- Search Plan and Results: HF: Sodium and Fluid (2014)
In patients with heart failure (NYHA Classes I-IV/AHA Stages B and C), what is the effect of sodium or fluid intake on quality measures (readmissions rate, length of stay, mortality)?
- Conclusion
  In patients with heart failure (NYHA Classes I-IV/AHA Stages B and C), research reported that among subjects receiving one liter of fluid per day, those consuming 2,800mg sodium per day had significantly reduced re-admissions rate, length of stay and mortality rate than those consuming 1,800mg sodium per day. However, among subjects receiving 2.0 liters to 2.4 liters of fluid per day, subjects consuming 2,800mg of sodium per day or more had significantly higher mortality rates than subjects consuming 1,900mg sodium per day or less and no patient death was observed in the middle tertile of 2,000mg to 2,700mg of sodium per day. Further research is needed regarding the effect of sodium or fluid intake on quality measures.
- Grade: III
  - Grade I means there is Good/Strong evidence supporting the statement;
  - Grade II is Fair;
  - Grade III is Limited/Weak;
  - Grade IV is Expert Opinion Only;
  - Grade V is Not Assignable.
  - High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
  - Moderate (B) means we are moderately confident in the effect estimate;
  - Low (C) means our confidence in the effect estimate is limited;
  - Very Low (D) means we have very little confidence in the effect estimate.
  - Ungraded means a grade is not assignable.
- Evidence Summary: In patients with heart failure (NYHA Classes I–IV/AHA Stages B and C), what is the effect of sodium or fluid intake on quality measures (readmissions rate, length of stay, mortality)?
- Search Plan and Results: HF: Sodium and Fluid (2014)