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Patients with mild heart failure should restrict their sodium intake (2–3 g daily) to help control blood pressure and edema, according to the Heart Failure Society of America (HFSA) practice guideline. Those with moderate or severe heart failure should ingest even less: 2 g daily, the guideline advises.
Yet most Americans average 3–4 g of sodium a day, mostly from processed and restaurant foods, reveal data from the National Health and Nutrition Examination Survey (NHANES).1 To help heart failure patients meet the HFSA goals, clinicians need to show them how much salt they're already eating and share practical strategies for helping them cut back, said Sandra Dunbar, RN, DSN, FAAN, at HFSA's 11th Annual Scientific Meeting, September 16–19 in Washington, D.C.
"Patients are often surprised to hear that they can reduce their daily sodium intake 20–40% just by removing one high-salt food," says Dunbar, a cardiovascular nursing professor at Emory University in Atlanta, who has found this pattern in her own clinical work.
Many patients are also surprised to hear that sea salt typically does not contain less sodium than regular table salt—a common myth—and to learn how much sodium lurks in processed foods, such as canned foods and soups, Dunbar says. That's where label reading comes in; patients need written and verbal instructions on tallying up daily sodium intake from store-bought foods and learning to cook with lower sodium ingredients, says Dunbar.
One helpful tip: Try to make sure that each serving you eat contains 
5%
of the Food and Drug Administration (FDA) recommended daily value (DV) for
sodium to keep levels low. (Note that 
20% DV of sodium per serving is
high.) FDA's recommended total DV for sodium is 2,400 mg, or 2.4 g.
Physicians can refer patients to dietitians and nurses for tailored dietary guidance. And they can further help by giving patients feedback on 3-day food diaries and 24-hour urinary sodium values collected from samples brought to the physician's office, says Dunbar. In addition, they should suggest salt-reduction strategies during every patient visit, Dunbar says.
Specific strategies to share include:
Footnotes
The Heart Failure Society of America (HFSA) Comprehensive Heart Failure Practice Guideline is online at www.heartfailureguideline.org.
HFSA's patient education booklet, "How to Follow a Low-Sodium Diet," is available at www.hfsa.org/pdf/module2.pdf.
More information on sodium-reduction strategies is available from the International Food Information Council at www.ific.org/publications/reviews/sodiumir.cfm.
Further information on America's salt-consumption habits is on the Centers for Disease Control and Prevention Web site at www.cdc.gov/nchs/data/nhanes/databriefs/calories.pdf.
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