"Even a minor decrease in a person's serum sodium level – levels that are now dismissed by physicians – had a major impact on mortality of heart failure patients," says Mihai Gheorghiade, MD, associate chief, Division of Cardiology, Northwestern Memorial Hospital and Northwestern University Feinberg School of Medicine, and lead presenter of the findings from the ESCAPE trial during a poster session on Monday.
Heart failure is a major health threat in this country, resulting in 1 million hospital admissions each year. "These findings illustrate that not all heart failure is created equally – heart failure accompanied with hyponatremia is especially dangerous. Levels of serum sodium may prove a useful and easily accessible risk assessment tool in the clinical management of patients hospitalized for heart failure," says Dr. Gheorghiade.
The good news is that a separate study presented Monday by Dr. Gheorghiade showed that improvement in sodium serum levels during hospitalization was associated with improved outcomes. In the ACTIV trial, patients with a serum sodiuim improvement at hospital discharge had a 15.6 percent mortality rate at 60 days post discharge, compared with a 30.4 percent mortality rate in those showing no improvement. "Currently, the medical community is not paying much attention to serum sodium levels in heart failure patients. However, serum sodium appears to be a modifiable target that can be treated," says Dr. Gheorghiade.
A paper authored by Dr. Gheorghiade and published in JAMA in April of 2004 found that the medication tolvaptan was a promising addition to standard therapy for patients hospitalized with heart failure. In addition to reducing fluid buildup and decreasing body weight, tolvaptan improved serum sodium levels in patients with hyponatremia. "This is important because previously, we have not had very effective therapies for treating hyponatremia in patients with heart failure. Now, we think it can be treated, and we have an understanding that treating it can make a huge difference for the patient," says Dr. Gheorghiade.
Sodium is an electrolyte that helps with nerve and muscle function, and also helps to maintain blood pressure. Hyponatremia most commonly occurs in people whose kidneys do not function properly, as well as in those with heart failure, cirrhosis of the liver, and Addison's disease. Sodium must be maintained at a specific concentration in the blood and the fluid surrounding the body's cells for the body to function properly.
About Northwestern Memorial Hospital
Northwestern Memorial Hospital is one of the country's premier academic medical centers and is the primary teaching hospital of Northwestern University's Feinberg School of Medicine. Northwestern Memorial and its Prentice Women's Hospital and Stone Institute of Psychiatry have 744 beds and more than 1,200 affiliated physicians and 5,000 employees. Providing state-of-the-art care, Northwestern Memorial is recognized for its outstanding clinical and surgical advancements in such areas as cardiothoracic and vascular care, gastroenterology, neurology and neurosurgery, oncology, organ and bone marrow transplantation, and women's health.
Northwestern Memorial was ranked as the nation's 5th best hospital by the 2002 Consumer Checkbook survey of the nation's physicians and is listed in the majority of specialties in this year's US News & World Report's issue of "America's Best Hospitals." The hospital is also cited as one of the "100 Best Companies for Working Mothers" by Working Mother magazine and has been chosen by Chicagoans year after year as their "most preferred hospital" in National Research Corporation's annual survey.
About the Bluhm Cardiovascular Institute
The Bluhm Cardiovascular Institute at Northwestern Memorial Hospital is a world-class heart program offering comprehensive services and state-of-the-art surgical treatments in all areas of cardiovascular care. Recently named by Solucient, an industry-leading healthcare information provider, as the only Chicago hospital on its list of the country's 100 Top Cardiovascular Hospitals, Northwestern Memorial Hospital offers a timely response to referrals and a multidisciplinary approach that joins physicians, nurses and a range of other medical specialists and caregivers from Cardiology, Cardiac Surgery, Vascular Surgery, Cardiovascular Anesthesiology and Radiology from evaluation to follow-up. Patients benefit from the latest minimally invasive surgical techniques and are offered the opportunity to participate in a range of clinical research trials.
Advanced Cardiovascular Care
Patients referred to the Bluhm Cardiovascular Institute experience a healthcare environment in which the most advanced diagnostic and treatment options are supported by state-of-the-art technology and a commitment to medical excellence through research. Expertise is available in all areas of cardiovascular care, including:
Cardiac Surgery
Vascular Surgery
Cardiology