The Evidence Synthesis Program (ESP) was asked by the Veterans Health Administration (VHA) Hospital Medicine for an evidence review on interventions affecting sodium intake (eg, dietary sodium restriction and supplemental sodium chloride [NaCl] given as either hypertonic saline solution [HSS] infusion or oral NaCl tablets) for adults .18 years of age hospitalized for acute decompensated heart failure (ADHF). For decades, standard non-pharmacologic inpatient care for people with ADHF has included restricting dietary sodium intake. However, evidence on the benefit of sodium restriction in the inpatient setting is mixed and there are concerns of harms, particularly related to antidiuretic effects and poor nutritional intake. In contrast, several studies suggest that the use of supplemental sodium in combination with an intravenous diuretic regimen may improve kidney function and reduce mortality in patients with ADHF. Veterans and providers could benefit from clear guidance on the use of sodium intake interventions to manage ADHF in an inpatient setting. VHA Hospital Medicine intends to use this ESP review to inform national clinical guidance on sodium restriction during acute care for patients with ADHF.
