Investigator Perspectives on SODIUM-HF Outcomes, Dietary Changes For HF Care

A dietary intervention to reduce sodium intake did not lead to a reduction in clinical events in patients with chronic heart failure, according to new results from the SODIUM-HF trial.

Attempting to reduce sodium intake to ≤1500 mg daily was no more effective than usual care in reducing the risk of hospitalization or emergency department visits due to cardiovascular causes.

The late-breaking findings were presented at the American College of Cardiology (ACC) Scientific Sessions in Washington, DC by Justin Ezekowitz, MBBCh MSc, Co-Director, Canadian VIGOUR Centre.

In an interview with HCPLive, Ezekowitz provided his perspective on the pragmatic trial and particuarly, assessing dietary and lifestyle based interventions for heart failure.

"We have great advances over the last few decades," he said. "I think we are just starting to need to put our usual practices such as diet interventions, fluid restriction, weight management, all these other factors that we seem to kind of carry forward from the prior generation of training and teaching, and really test them in RCTs."

Ezekowitz noted the secondary endpoints of the trial showed some benefit of dietary intervention, including quality of life and NYHA class.

"My view is that we have these other therapies including pharmacologic and device therapies, for good reason they work they've been tested in RCTs," he noted. "I still think that patient self care is quite important, and dietary modification or dietary changes are something we can think about as part of a comprehensive overall heart healthy approach."

Questions remain on what patients are eating and what the implications are for the best medical therapy, so Ezekowitz still believes it is appropriate to study diet for heart failure.

The SODIUM-HF trial will continue with a 2-year and 5-year follow-up. Ezekowitz stated his belief that the benefits of a low sodium diet take time to accrue.

"We may see differences at the two year mark or five year mark that we haven't seen at the one year mark yet, that comes with an expectation that patients continue on in their therapies, but their background therapies may have also changed as news therapies come along for an individual patient."

Ezekowitz made the point that no trial is perfect, therefore there are issues in how the trial is interpreted. But, he noted that this is the best test so far and the larges trial of its kind.

"And so we should look at this trial as the first step in a perhaps a longer journey to understanding whether or not dietary changes make a difference for our patients with heart failure," he said.