Poll: Sodium Restriction in Patients With Heart Failure With Reduced Ejection Fraction

Heart failure (HF) is one of the leading causes of cardiovascular morbidity and mortality. Slightly more than half of patients with HF have heart failure with reduced ejection fraction (HFrEF)1 which is associated with neurohormonal activation and autonomic abnormalities leading to sodium and water retention. As such, HF guidelines recommend avoiding excessive intake of sodium to prevent fluid retention in these patients.2 However, a recently published study, SODIUM-HF, called into question this practice as a dietary intervention intended to reduce sodium intake but failed to reduce clinical event in this open-label, randomized, controlled clinical trial.3

The following survey, therefore, is intended for all providers caring for HF patients in various healthcare settings including specialty centers, hospitals, primary care centers and community centers.

Clinical Scenario: A 65-year-old female with HFrEF (EF 35%) with a recent hospitalization for decompensated HF 1.5 months ago sees you in clinic. She has history of coronary artery disease (CAD) s/p percutaneous coronary intervention (PCI) with DESx2, s/p implantable cardioverter defibrillator (ICD) for primary prevention, hypertension, and type 2 diabetes mellitus. She does not have any valvular heart disease and does not meet criteria for cardiac resynchronization therapy (CRT) upgrade. She is on guideline-directed medical therapy (GDMT) with losartan 50 mg, metoprolol succinate 100 mg and spironolactone 25 mg.


  1. Tsao CW, Aday AW, Almarzooq ZI, et al. Heart Disease and Stroke Statistics-2022 Update: a report from the American Heart Association. Circulation 2022;145:e153-e639.
  2. Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure: executive summary: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2022;79:1757-80.
  3. Ezekowitz JA, Colin-Ramirez E, Ross H, et al. Reduction of dietary sodium to less than 100 mmol in heart failure (SODIUM-HF): an international, open-label, randomised, controlled trial. Lancet 2022;399:1391-1400.

Clinical Topics: Arrhythmias and Clinical EP, Diabetes and Cardiometabolic Disease, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Prevention, Pulmonary Hypertension and Venous Thromboembolism, Valvular Heart Disease, Vascular Medicine, Atherosclerotic Disease (CAD/PAD), Implantable Devices, SCD/Ventricular Arrhythmias, Acute Heart Failure, Pulmonary Hypertension, Interventions and Coronary Artery Disease, Interventions and Structural Heart Disease, Interventions and Vascular Medicine, Diet, Hypertension

Keywords: ACC Annual Scientific Session, ACC22, Stroke Volume, Heart Failure, Losartan, Metoprolol, Spironolactone, Cardiac Resynchronization Therapy, Coronary Artery Disease, Defibrillators, Implantable, Diabetes Mellitus, Type 2, Percutaneous Coronary Intervention, Sodium, Dietary, Sodium, Diet, Sodium-Restricted, Hospitalization, Heart Valve Diseases, Primary Prevention, Hypertension, Hypertension, Pulmonary, Primary Health Care, Delivery of Health Care

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