KMID : 0338420150300040460
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The Korean Journal of Internal Medicine 2015 Volume.30 No. 4 p.460 ~ p.470
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Prognostic value of hyponatremia in heart failure patients: an analysis of the Clinical Characteristics and Outcomes in the Relation with Serum Sodium Level in Asian Patients Hospitalized for Heart Failure (COAST) study
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:Yoo Byung-Su
:Park Jin-Joo/:Choi Dong-Ju/:Kang Seok-Min/:Juey-Jen Hwang/:Shing-Jong Lin/:Ming-Shien Wen/:Jian Zhang/:Junbo Ge
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Abstract
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Background/Aims: Hyponatremia is a well-known risk factor for poor outcomes in Western studies of heart failure (HF) patients. We evaluated the predictive value of hyponatremia in hospitalized Asian HF patients.
Methods: The Clinical Characteristics and Outcomes in the Relation with Serum Sodium Level in Asian Patients Hospitalized for Heart Failure (the COAST) study enrolled hospitalized patients with systolic HF (ejection fraction < 45%) at eight centers in South Korea, Taiwan, and China. The relationship between admission sodium level and clinical outcomes was analyzed in 1,470 patients.
Results: The mean admission sodium level was 138 ¡¾ 4.7 mmol/L, and 247 patients (16.8%) had hyponatremia defined as Na+ < 135 mmol/L. The 12-month mortality was higher in hyponatremic patients (27.9% vs. 14.6%, p < 0.001), and hyponatremia was an independent predictor of 12-month mortality (hazard ratio, 1.72; 95% confidence interval, 1.12 to 2.65). During hospital admission, 57% of hyponatremic patients showed improvement without improvement in their clinical outcomes (p = 0.620). The proportion of patients with optimal medical treatment was only 26.5% and 44.2% at admission and discharge, respectively, defined as the combined use of angiotensin-converting-enzyme inhibitor/angiotensin receptor blocker and ¥â-blocker. Underuse of optimal medical treatment was more pronounced in hyponatremic patients.
Conclusions: In hospitalized Asian HF patients, hyponatremia at admission is common and is an independent predictor of poor clinical outcome. Furthermore, hyponatremic patients receive less optimal medical treatment than their counterparts.
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KEYWORD
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Hyponatremia, Predictor of clinical outcomes, Hospitalized heart failure, East Asians
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