Hyponatremia in heart failure

In this study most heart failure patients with hyponatremia on admission were discharged hyponatremic. Among treatment approaches fluid restriction was most common. No deliberate attempt to lower serum sodium ranked second. Despite heavy promotion hardly anybody used tolvaptan.

From the Clinical Perspective portion of the paper:

Clinical Perspective

What Is New?

Hyponatremia (HN) is common in patients hospitalized with acute heart failure and is associated with worse outcomes.

We examined current practices for the management of HN in 762 patients with acute heart failure.

Fluid restriction was the most commonly used strategy for correcting HN; however, nearly one quarter received no specific therapy.

What Are the Clinical Implications?

Most patients with HN remained hyponatremic at discharge.

Further studies are needed to determine optimal approaches to effectively correct HN the inpatient setting.

The last sentence above reflects the wrong perspective. Hyponatremia is indeed a predictor of worse outcomes but not as a result of the sodium concentration itself. Rather, it is because it is a marker of neurohumeral activation. Antagonizing the neurohumeral response has been the focus of treatment of systolic heart failure for decades. One class of neurohumeral antagonists, the aldostone receptor antagonists, has the effect of lowering serum sodium.