Dietary sodium restriction below 2 g per day predicted shorter event-free survival in patients with mild heart failure

Eun Kyeung Song, Debra K. Moser, Sandra B. Dunbar, Susan J. Pressler, Terry A. Lennie

Research output: Contribution to journalArticlepeer-review

24 Scopus citations


Background: Despite a growing recognition that a strict low sodium diet may not be warranted in compensated heart failure (HF) patients, the link between sodium restriction below 2 g/day and health outcomes is unknown in patients at different levels of HF severity.

Purpose: The purpose of this study was to compare differences in event-free survival among patients with <2 g/day, 2-3 g/day, or >3 g/day sodium intake stratified by New York Heart Association (NYHA) class.

Method: A total of 244 patients with HF completed a four-day food diary to measure daily sodium intake. All-cause hospitalization or death for a median of 365 follow-up days and covariates on age, gender, etiology, body mass index, NYHA class, ejection fraction, total comorbidity score, the presence of ankle edema, and prescribed medications were determined by patient interview and medical record review. Hierarchical Cox hazard regression was used to address the purpose.

Results: In NYHA class I/II (n=134), patients with <2 g/day sodium intake had a 3.7-times higher risk (p=0.025), while patients with >3 g/day sodium intake had a 0.4-times lower risk (p=0.047) for hospitalization or death than those with 2-3 g/day sodium intake after controlling for covariates. In NYHA class III/IV (n=110), >3 g/day sodium intake predicted shorter event-free survival (p=0.044), whereas there was no difference in survival curves between patients with <2 g/day and those with 2-3 g/day sodium intake.

Conclusion: Sodium restriction below 2 g/day is not warranted in mild HF patients, whereas excessive sodium intake above 3 g/day may be harmful in moderate to severe HF patients.

Original languageEnglish
Pages (from-to)541-548
Number of pages8
JournalEuropean Journal of Cardiovascular Nursing
Issue number6
StatePublished - Dec 24 2014

Bibliographical note

Funding Information:
Grant/financial support were as follows: Funding Sources: (1) National Institute of Health (NIH) /National Institute Nursing Research (NINR) 3R01 NR 009280 (Lennie, T.A., Primary investigator [PI]); (2) NIH/ NINR 1P20 NR 010679 (Moser, D.K., PI); (3) Emory University General Clinical Research Center M01RR0039, the National Center for Advancing Translational Sciences of the NIH, Award Number UL1TR000454, and the Atlanta Veterans Administration Medical Center; (4) Basic Science Research Program through the National Research Foundation of Korea (NRF) Grant by the Korean Government (NRF-2011-0024857) (Song, E. K., PI).

Publisher Copyright:
© The European Society of Cardiology 2013.


  • Sodium-restricted diet
  • health outcomes
  • heart failure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Medical–Surgical
  • Advanced and Specialized Nursing


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