Sept. 26, 2024
Despite medical advances, heart failure is the most frequent reason for hospitalization among patients age 65 years and older.
Medications are one part of heart failure management. Mayo Clinic researchers recently took a closer look at another method of heart failure management: managing sodium and fluid intake to sustain clinical equilibrium and safeguard renal function.
In a recent article published in Mayo Clinic Proceedings: Innovations, Quality & Outcomes, Rohan M. Goswami, M.D., a transplant cardiologist at Mayo Clinic in Jacksonville, Florida and one of the study's authors, looks at the impact of sodium and fluid levels on heart failure treatment.
They find that when patients with heart failure restrict their sodium and fluid levels, it is a simple but powerful tool for condition management. Practical guidelines that the authors suggest include limiting fluid intake to 50 oz. a day and salt intake to 2,000 mg a day.
Managing sodium and fluid levels is a delicate balance
With heart failure management, the margin between dehydration and volume overload is narrow. The goals are to:
- Restore fluid balance.
- Protect cardiac performance from further deterioration.
Patients with right heart failure face additional complexity. Their condition can cause progressive renal retention of salt and water, which worsens heart failure symptoms.
Despite these challenges, sodium and fluid restriction gives patients with heart failure a way to manage their condition without medication or surgery.
Evidence supporting sodium and fluid restriction
Limited data support sodium and fluid restriction, but the authors share that "these measures are recommended in textbooks and clinical practice guidelines, and they work."
Evidence does exist supporting the use of sodium restriction to improve outcomes, particularly for severe cases. Sodium restriction can lessen myocardial stress, improving heart failure symptoms.
Sodium restriction also can be a helpful strategy for patients who are experiencing diuretic resistance to their medication and patients who are medication noncompliant.
New sodium intake guidelines for heart failure patients
Recent sodium intake guidelines include:
- The American Heart Association recommends less than 1,500 mg of sodium daily for the general population. On average, Americans consume 3,400 to 3,700 mg of sodium daily.
- The Heart Failure Society of America suggests 2,000 to 3,000 mg of sodium a day for people with heart failure. For people with moderate to severe heart failure, they suggest less than 2,000 mg a day.
The study suggests two specific guidelines for patients with heart failure:
- Limit fluid intake to 50 oz. a day, including fruit servings.
- Limit salt intake to 2,000 mg a day, including these strategies:
- Stop eating canned foods.
- Only eat frozen foods that are free of preservatives.
- Verify salt alternatives with a healthcare professional first.
The authors note that personalizing restrictions for each patient is key. This ensures the restriction will work with a patient's medication plan and diet. It also helps avoid risks such as hyponatremia.
Dr. Goswami and his co-author suggest that salt and fluid restriction is a simple but powerful tool for heart failure management: "It's time to return to a way of dealing with heart failure, where simple things become powerful tools for changing lives."
For more information
Sharma S, et al. Fluid and salt balance are things we often overlook: Could our understanding of fluid dynamics change how we tackle heart failure? Mayo Clinic Proceedings: Innovations, Quality & Outcomes. 2024;8:184.
American Heart Association
The Heart Failure Society of America
Refer a patient to Mayo Clinic.