PMID- 21701268
OWN - NLM
STAT- MEDLINE
DCOM- 20110823
LR  - 20131121
IS  - 1538-2990 (Electronic)
IS  - 0002-9629 (Linking)
VI  - 342
IP  - 1
DP  - 2011 Jul
TI  - Short-term effects of hypertonic saline solution in acute heart failure and 
      long-term effects of a moderate sodium restriction in patients with compensated 
      heart failure with New York Heart Association class III (Class C) (SMAC-HF 
      Study).
PG  - 27-37
LID - 10.1097/MAJ.0b013e31820f10ad [doi]
AB  - INTRODUCTION: Hypertonic saline solution (HSS) and a moderate Na restriction plus 
      high furosemide dose showed beneficial effects in compensated heart failure (HF), 
      in short and long terms. The study was aimed to verify the effects of this 
      combination on hospitalization time, readmissions and mortality in patients in 
      New York Heart Association (NYHA) class III. METHOD: Chronic ischemic or 
      nonischemic cardiomyopathy uncompensated patients with HF in NYHA III functional 
      class with ejection fraction <40%, serum creatinine <2.5 mg/dL, blood urea 
      nitrogen <60 mg/dL and reduced urinary volume were single-blind randomized in 2 
      groups: the first group received a 30-minute intravenous infusion of furosemide 
      (250 mg) plus HSS (150 mL) twice daily and a moderate Na restriction (120 mmol); 
      the second group received furosemide intravenous bolus (250 mg) twice a day, 
      without HSS and a low Na diet (80 mmol); both groups received a fluid intake of 
      1000 mL/d. After discharge, the HSS group continued with 120 mmol Na/d; the 
      second group continued with 80 mmol Na/d. RESULTS: A total of 1771 patients (881 
      HSS group and 890 without HSS group) met inclusion criteria: the first group (881 
      patients), compared with the second (890 patients), showed an increase in 
      diuresis and serum Na levels, a reduction in hospitalization time (3.5 + 1 versus 
      5.5 + 1 days, P < 0.0001) and, during follow-up (57 + 15 months), a lower rate in 
      readmissions (18.5% versus 34.2%, P < 0.0001) and mortality (12.9% versus 23.8%, 
      P < 0.0001); the second group also showed a significant increase in blood urea 
      nitrogen and serum creatinine. CONCLUSION: This study suggests that in-hospital 
      HSS administration, combined with moderate Na restriction, reduces 
      hospitalization time and that a moderate sodium diet restriction determines 
      long-term benefit in patients with NYHA class III HF.
FAU - Paterna, Salvatore
AU  - Paterna S
AD  - Biomedical Department of Internal Medicine, University of Palermo, Italy.
FAU - Fasullo, Sergio
AU  - Fasullo S
FAU - Parrinello, Gaspare
AU  - Parrinello G
FAU - Cannizzaro, Sergio
AU  - Cannizzaro S
FAU - Basile, Ivana
AU  - Basile I
FAU - Vitrano, Gabriella
AU  - Vitrano G
FAU - Terrazzino, Gabriella
AU  - Terrazzino G
FAU - Maringhini, Giorgio
AU  - Maringhini G
FAU - Ganci, Filippo
AU  - Ganci F
FAU - Scalzo, Sebastiano
AU  - Scalzo S
FAU - Sarullo, Filippo M
AU  - Sarullo FM
FAU - Cice, Gennaro
AU  - Cice G
FAU - Di Pasquale, Pietro
AU  - Di Pasquale P
LA  - eng
PT  - Journal Article
PT  - Randomized Controlled Trial
PL  - United States
TA  - Am J Med Sci
JT  - The American journal of the medical sciences
JID - 0370506
RN  - 0 (Saline Solution, Hypertonic)
RN  - 7LXU5N7ZO5 (Furosemide)
RN  - 9NEZ333N27 (Sodium)
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Diet, Sodium-Restricted
MH  - Diuresis
MH  - Female
MH  - Furosemide/*administration & dosage
MH  - Heart Failure/*drug therapy
MH  - Hospitalization
MH  - Humans
MH  - Infusions, Intravenous
MH  - Male
MH  - Middle Aged
MH  - Patient Readmission
MH  - Saline Solution, Hypertonic/*therapeutic use
MH  - Sodium/blood/chemistry
MH  - Treatment Outcome
EDAT- 2011/06/28 06:00
MHDA- 2011/08/24 06:00
CRDT- 2011/06/25 06:00
PHST- 2011/06/25 06:00 [entrez]
PHST- 2011/06/28 06:00 [pubmed]
PHST- 2011/08/24 06:00 [medline]
AID - S0002-9629(15)31239-8 [pii]
AID - 10.1097/MAJ.0b013e31820f10ad [doi]
PST - ppublish
SO  - Am J Med Sci. 2011 Jul;342(1):27-37. doi: 10.1097/MAJ.0b013e31820f10ad.