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Review question/objective The objective of this review is to identify the effectiveness of reduced dietary salt intake on readmission and mortality rates. More specifically, the objectives are to identify the effectiveness of low dietary salt intake on readmission and mortality in patients with heart failure. Background Heart failure is a disease with one of the highest mortality rates in the Western world.1 Heart failure patients have a poor prognosis, with a five‐year mortality rate of 68.7% and a median survival time of 2.4 years.2 Heart failure is also associated with reduced quality of life and frequent readmissions to hospital.3 Recommendations have been developed by the European Cardiology Society (ECS) that guide the use of pharmacological and non‐pharmacological interventions for patients with heart failure.4,5 Non‐pharmacological interventions focus mainly on lifestyle changes and changes of behavior in everyday life and must be systematically incorporated into the treatment and rehabilitation of patients with heart failure.5 These behavioral changes can be interpreted as a significant part of the individual's self‐care and a component of their future health behavior. The readmission rate is high for patients with heart failure and this “might be an indicator for low self‐care behavior”.11 Self‐care encompasses the actions aimed at maintaining physical stability, avoidance of the behaviors that can worsen the condition and detection of the early symptoms of deterioration. Translating non‐pharmacological recommendations from the ECS means that patients should be giving increased attention to fluid intake, dietary salt intake and observation of symptoms.3,6‐9 Self‐care requires the active involvement of the patient who takes responsibility for the care and treatment they receive and ensures that the recommendations given to them by the health care system are valid and current. A Cochrane review has found that a reduction of dietary sodium intake is generally beneficial for cardiac patients. However, it also indicated that a reduced dietary sodium intake could be harmful for patients with heart failure and may potentially even increase the risk of mortality.10 Few public health policies have been as widely endorsed for lowering cardiovascular disease (CVD) morbidity and mortality as dietary sodium restriction.12 This policy can be dated back to Kempner's observation that extreme sodium restriction tempered the hypertensive crisis associated with renal insufficiency.13 Subsequently, sodium restriction was gradually incorporated into the management of many patients with essential hypertension as an adjunct therapy to antihypertensive drugs.14 Normal dietary salt intake in the Scandinavian population is reported to be six grams per day for women and nine grams per day for men. Both the European and American guidelines recommend a reduction of dietary sodium intake for patients with heart failure. The recommended levels of sodium intake have been two to three grams per day with further restriction (below two grams per day) to be considered in patients with moderate to severe heart failure.13,14 These recommendations are based on level C evidence, that is, expert consensus opinion and results from observational studies. However, some studies indicate that this might be harmful for patients; therefore a systematic review of the evidence is needed. An initial search in the data bases CINAHL, JBI COnNECT+, DARE, PubMed, Cochrane Library and PROSPERO showed that no systematic review exists on this topic, or is currently underway.

jbi database of systematic reviews and implementation reports

The effectiveness of reducing dietary sodium intake versus normal dietary sodium intake in patients with heart failure on reducing readmission rate: a systematic review protocol