Collections > Master's Papers > Gillings School of Public Health > A Pinch of Salt: A Review of Educational Interventions for Adherence to Sodium-Restricted Diets in Heart Failure

Heart failure (HF) is prevalent worldwide, affecting approximately 26 million people. In the United States, one in nine deaths is at least partially attributed to HF. More than 1 million patients are hospitalized yearly for HF and over 50% of these patients are readmitted within 6 months of discharge. HF has a high economic cost, with totals projected to reach $61.4 billion by 2020, as well as a negative impact on patients’ quality of life (QOL). Patients with HF experience impairments including role limitation due to physical problems, decrease in social and physical functioning, lack of energy, difficulty sleeping, shortness of breath, and edema. Rehospitalization has been demonstrated to worsen QOL and poor QOL has been identified as a risk factor for mortality and hospital readmission. Furthermore, higher incidence of HF and HF-related mortality have been noted in African Americans, especially men, and patients from lower socioeconomic status, indicating that HF is a health disparity issue. Identifying successful strategies to reduce the social and economic burden of HF by decreasing HF patient hospitalizations is a valuable endeavor. In addition to pharmacological therapy, behavioral self-management is typically part of a HF treatment plan. A sodium restricted diet (SRD) is consistently recommended as a self-management strategy. While consensus on an optimal level of sodium restriction has not been reached, SRD is consistently recommended as a non-pharmacological treatment of HF. This recommendation is based on a plausible physiological mechanism in which a low cardiac output leads to activation of renin which, through a series of biological responses, increases sodium retention. This reninangiotensin-aldosterone system-activated sodium retention coupled with excess dietary sodium is associated with fluid retention. Observational studies have associated SRD with lower symptom burden, all-cause hospitalization, mortality, and event-free survival.