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During the congress, E-Posters will be accessible to all participants on the congress website 24/7, as well as in the E-poster stations in the congress center.
Preparing your E-Poster
Please review the E-Poster format requirements carefully when preparing your E-Poster. Should your E-Poster not meet the mentioned requirements, it may not be displayed as described above.
E-Poster Submission Deadline
Please prepare and upload your E-Poster no later than March 14, 2026 11.59PM CET. After this date, you will no longer be able to prepare and upload your E-poster and it will not be displayed and accessible on the congress website.
Please follow the instructions below to input your abstract title.
Abstract titles should be brief and reflect the content of the abstract.
Acute heart failure is the rapid onset or worsening of symptoms and/or signs of heart failure, which requires urgent evaluation and treatment. It is mostly a clinical diagnosis with symptoms and/or signs caused by a structural and/or functional cardiac abnormality and corroborated by elevated natriuretic peptide levels and/or objective evidence of pulmonary or systemic congestion. In most patients, the major cause for admission is volume overload. Sodium and water retention in the extracellular space is the major mechanism contributing to volume overload and the mainstay of treatment is administration of diuretics, especially loop diuretics, intravenously along with supportive care. Appropriate treatment improves survival and also lowers re-hospitalisation rates.
The appropriate dosing of loop diuretics for patients with acute heart failure is a dynamic process which needs clinical and hemodynamic assessment along with biochemical and echocardiographic analysis. Commonly, peripheral edema, weight changes, urine output and levels of BNP are used as parameters to guide the diuretic dosing. But there is a need for objective assessment to monitor the dosing as well as correlate the clinical improvement.
Natriuresis assessed by urinary spot sodium and spot chloride levels, which is an economical as well as easy to access tool, which if assessed at appropriate intervals will help in guiding diuretic therapy as well as in deciding on ultrafiltration in case of diuretic resistance. This will help in faster decongestion, hence reducing hospital stay as well as improving patient outcomes.
Study design: Prospective observational cohort study
AIMS AND OBJECTIVES:
1. To assess the urinary spot sodium and spot chloride levels in patients admitted with acute heart failure to guide diuretic therapy.
2. To assess the difference in natriuresis assessment based on the dosing of loop diuretics (bolus doses/continuous infusions), if any.
3. To follow up and assess the all cause mortality and re-hospitalisation rates over a period of a period of 6 months, post discharge.
SAMPLE SIZE: 118 patients
Duration of study- 12 months
Inclusion Criteria:
1. Patients aged more than 18 years
2. Patients admitted with acute heart failure to Kauvery Hospital, Chennai
Exclusion criteria:
1. Patients with eGFR <15ml/min
2. Patients with severe hepatic dysfunction
3. Patients with sepsis
4. Age <18 years
5. Patients who do not consent for the study
The study participants were selected based on the 2D Echocardiography and ejection fraction levels. The clinical history and baseline investigations were collected among the study participants. Urine spot sodium and spot chloride levels was checked at baseline, 2hrs, 24hrs and 48 hrs post diuretic use. The treating physicians were blinded to the urine sodium and chloride values. All patients were followed up for a period of 6 months post discharge. Statistical analysis was performed using SPSS, (Version 20.0). Ethical approval was obtained from the Insititutional Ethics Committee.
Lesser Urine sodium at 24 hours (P=0.015) and 48 hours (P=0.024) was significantly associated with in hospital death. Urine spot sodium at 24 hours is the best predictor of in hospital mortality with best cut off point of 64.75. The next best predictor is Urine spot sodium at 48 hours with best cut off point of 76.25.
Lower mean urine spot sodium (P=0.036) and chloride (p=0.037) was significantly associated with mortality due to any cause at 6 months. Urine spot sodium at 48 hours is the best predictor of all cause mortality at 6 months with best cut off point of 115.05
Lower mean urine spot sodium (P=0.033) and chloride (p=0.028) at 48 hours and more decrease in Urine spot sodium from 24 to 48 hours is significantly associated with the need for mechanical ventilation. (P=0.017). Urine spot chloride at 48 hours is the best predictor of need for mechanical ventilation with best cut off point of 99.50. Urine spot chloride at 48 hours is the best predictor of need for mechanical ventilation with best cut off point of 99.5.
Lower mean urine spot sodium and chloride at baseline (P=0.029 for UNa and P=0.006 for UCl) and 24 hours (P=0.032 for UNa and P=0.005 for UCl) and increase in change in urine spot chloride at 2 hours is significantly associated with increase in the length of hospital stay. (P=0.007). Urine spot chloride at 24 hours is the best predictor of length of hospital stay more than 5 days with best cut off point of 68.45.
Low Urine sodium best predicts in hospital mortality and all cause mortality at 6 months. Low Urine spot chloride best predicts need for mechanical ventilation and longer hospital stay. Change in Urine spot chloride best predicts hospitalisation due to heart failure. Spot urine sodium and chloride lead to timely identification of patients at risk of mortality and HF rehospitalization so that intense decongestive therapy and earlier treatment with ultrafiltration to improve the volume overload can be initiated earlier leading to better outcomes.
