Hold the Salt: The Challenge of Helping HF Patients Manage Sodium

Keeping heart failure patients out of the hospital means keeping excess sodium out of their diet. This comes as no surprise to most clinicians, according to Terry A. Lennie, MD, University of Kentucky, but while many interventions prove that reducing salt is effective, they don’t show clinicians how this can be done.

In a presentation Tuesday at the HFSA 14th Annual Scientific Sessions entitled, “Managing Salt in the Diet,” Lennie tackled the biggest barriers to limiting sodium intake in patients. The abundance in salt and sodium in prepared and processed foods, difficulty preparing foods low in sodium, and the social component of family members that don’t follow a low-salt diet are the most significant challenges, with literacy and physiological issues also playing a role, he said.

The most effective way to get through to patients is to develop a knowledge-based intervention that can help patients build their own skills and includes support from family members. However, many interventions that have proven effective in studies tend be very labor- and time-intensive; and often, when the intervention ends, a limited number of patients recall and follow the advice provided by healthcare professionals.

There are strategies that can be used to achieve some results in patients, said Lennie, who recommends that clinicians deliver educational materials at an appropriate level for patients, considering factors such as proximity to grocery stores when recommending a diet based largely on fresh produce. He also advised recruiting the help of family members to provide support to the family by cooking with less salt and choosing foods lower in sodium

“We need to make sure that what we’re asking patients to do is achievable,” noted Lennie, who believes that the burden of limited sodium is placed too heavily on patients. “The burden needs to shift from individuals to the food industry.”

Finally, he explained that pallets can be retrained to crave and require less salt, citing a study in which changes in salt preference in response to sodium restriction decreased over time. Removing salt from food preparation and giving free access to salt shakers, he noted, can actually achieve positive results in patients who need to limit sodium intake.

Kirsten Bibbins-Domingo, MD, University of California, San Francisco, talked about the public health challenge of managing dietary salt, citing the fact that the current intake of both salt and sodium in the US far exceeds recommendations, and has increased significantly in recent years.

Studies show that reducing salt by even 3 grams per day can result in a reduction of new coronary heart disease events by about 10% across the population, with African Americans realizing an even greater benefit, according to Bibbins-Domingo. She also referred to the DASH trial, which showed that lower sodium resulted in lower systolic blood pressure.

“We all consume too much salt,” she noted. “Because salt is already added to the food we eat, individuals can’t make this change easily.”

Bibbins-Domingo encourages clinicians to become involved in advocacy efforts to push for government regulations and partnerships to achieve sustainable levels of salt reductions in patients.