Chronic heart failure: low serum chloride tied to increased mortality risk

  • Cuthbert JJ & al.
  • Eur J Heart Fail
  • 26 Jun 2018

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • Low sodium chloride levels may be adverse prognostic markers in patients with chronic heart failure irrespective of variables such as amino-terminal pro-B-type natriuretic peptide (NT-proBNP) or sodium.

Why this matters

  • The importance of serum chloride levels has been overlooked until now.
  • This study suggests novel findings: association between chloride levels and sudden death, biochemical phenotypes of hypochloraemia with implications for management.

Study design

  • Study enrolled 4705 patients with heart failure who had baseline data on ECG, NT-proBNP and serum chloride levels.
  • The primary outcomes assessed were all-cause mortality and a composite endpoint of mortality/hospitalisation with heart failure.
  • Funding: None disclosed.

Key results

  • 1988 patients had heart failure with reduced ejection fraction (HFrEF) and 2717 patients had heart failure with preserved ejection fraction (HFpEF).
  • Patients in the first quartile (median chloride, 96 mmol/L) vs second to fourth quartile (median chloride, 106 mmol/L) had:
    • Greater severity of symptoms (P<.001 and>
    • Greater likelihood for receiving loop diuretics (P<.001>
  • Each unit decrease in chloride level reflected a 4% rise in mortality (HR, 1.04; P<.001 and a rise in mortality with heart failure p>
  • However, there was a trend for increase in mortality with chloride level above the normal range (>105 mmol/L).

Limitations

  • Potential risk of confounders.

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