{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T20:09:47Z","timestamp":1787688587659,"version":"build-2784847793"},"reference-count":39,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,10,12]],"date-time":"2022-10-12T00:00:00Z","timestamp":1665532800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec><jats:title>Aim<\/jats:title><jats:p>The aim of this study is to evaluate the association between serum sodium concentrations at hospital admission and all-cause mortality within 365 days post-discharge in patients with atrial fibrillation (AF) without heart failure (HF).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The prospective cohort study enrolled 1,446 patients with AF without HF between November 2018 and October 2020. A follow-up was performed 30, 90, 180, and 365 days after enrollment through outpatient visits or telephone interviews. All-cause mortality was estimated in three groups according to serum sodium concentrations: hyponatremia (&amp;lt; 135 mmol\/L), normonatremia (135\u2013145 mmol\/L), and hypernatremia (&amp;gt; 145 mmol\/L). We estimated the risk of all-cause mortalities using univariable and multivariable Cox proportional hazards models with normonatremia as the reference.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The all-cause mortalities of hyponatremia, normonatremia, and hypernatremia were 20.6, 9.4, and 33.3% within 365 days post-discharge, respectively. In the univariable analysis, hyponatremia (HR: 2.19, CI 1.5\u20133.2) and hypernatremia (HR: 4.03, CI 2.32\u20137.02) increased the risk of all-cause mortality. The HRs for hyponatremia and hypernatremia were 1.55 (CI 1.05\u20132.28) and 2.55 (CI 1.45\u20134.46) after adjustment for age, diabetes mellitus, loop diuretics, antisterone, antiplatelet drugs, and anticoagulants in the patients with AF without HF. The association between serum sodium concentrations and the HRs of all-cause mortality was U-shaped.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Dysnatremia at hospital admission was an independent factor for all-cause mortality in patients with AF without HF within 365 days post-discharge.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fcvm.2022.963103","type":"journal-article","created":{"date-parts":[[2022,10,12]],"date-time":"2022-10-12T09:11:20Z","timestamp":1665565880000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["Dysnatremia is associated with increased risk of all-cause mortality within 365 days post-discharge in patients with atrial fibrillation without heart failure: A prospective cohort study"],"prefix":"10.3389","volume":"9","author":[{"given":"Yan","family":"Zhou","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dong","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shiwan","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiaxin","family":"Xiao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhongbo","family":"Xiao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muli","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhisheng","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cuihong","family":"Tian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rongbing","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yequn","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuerui","family":"Tan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,10,12]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1038\/s41572-022-00347-9","article-title":"Atrial fibrillation","volume":"8","author":"Brundel","year":"2022","journal-title":"Nat Rev Dis Primers"},{"key":"B2","doi-asserted-by":"publisher","first-page":"80","DOI":"10.4103\/hm.hm_25_20","article-title":"Program planning in education and light exercise training for atrial fibrillation patients: a feasibility study","volume":"4","author":"Tripp","year":"2020","journal-title":"Heart Mind."},{"key":"B3","doi-asserted-by":"publisher","first-page":"70","DOI":"10.4103\/hm.hm_41_19","article-title":"Emotional stress-induced takotsubo cardiomyopathy, acute heart failure, and atrial fibrillation in the same patient","volume":"3","author":"Ivanovic","year":"2019","journal-title":"Heart Mind."},{"key":"B4","doi-asserted-by":"publisher","first-page":"847","DOI":"10.1093\/eurheartj\/ehaa1077","article-title":"Paradoxical impact of socioeconomic factors on outcome of atrial fibrillation in Europe: trends in incidence and mortality from atrial fibrillation","volume":"42","author":"Al-Khayatt","year":"2021","journal-title":"Eur Heart J."},{"key":"B5","doi-asserted-by":"publisher","first-page":"1594","DOI":"10.1111\/liv.14461","article-title":"Nonalcoholic fatty liver disease is associated with increased risk of atrial fibrillation","volume":"40","author":"Cai","year":"2020","journal-title":"Liver Int."},{"key":"B6","doi-asserted-by":"publisher","first-page":"3059864","DOI":"10.1155\/2020\/3059864","article-title":"Decreased mortality with beta-blocker therapy in HFpEF patients associated with atrial fibrillation","volume":"2020","author":"Yang","year":"2020","journal-title":"Cardiol Res Pract."},{"key":"B7","doi-asserted-by":"publisher","first-page":"217","DOI":"10.1177\/1747493019897870","article-title":"Global epidemiology of atrial fibrillation: an increasing epidemic and public health challenge","volume":"16","author":"Lippi","year":"2021","journal-title":"Int J Stroke."},{"key":"B8","doi-asserted-by":"publisher","first-page":"2864","DOI":"10.1001\/jama.285.22.2864","article-title":"Validation of clinical classification schemes for predicting stroke: results from the national registry of atrial fibrillation","volume":"285","author":"Gage","year":"2001","journal-title":"Jama."},{"key":"B9","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1016\/j.amjmed.2019.05.026","article-title":"Is long-standing atrial fibrillation a biomarker of or contributor to the symptoms or progression of chronic heart failure?","volume":"133","author":"Packer","year":"2020","journal-title":"Am J Med."},{"key":"B10","doi-asserted-by":"publisher","first-page":"1","DOI":"10.4103\/hm.hm_61_19","article-title":"Usage and safety of direct oral anticoagulants at patients with atrial fibrillation and planned diagnostic procedures, interventions, and surgery","volume":"3","author":"Jelavic","year":"2019","journal-title":"Heart Mind."},{"key":"B11","doi-asserted-by":"publisher","first-page":"793","DOI":"10.1016\/j.amjcard.2018.05.015","article-title":"The disease burden of atrial fibrillation in china from a national cross-sectional survey","volume":"122","author":"Wang","year":"2018","journal-title":"Am J Cardiol."},{"key":"B12","doi-asserted-by":"publisher","first-page":"810","DOI":"10.1016\/j.chest.2017.03.048","article-title":"The global burden of atrial fibrillation and stroke: a systematic review of the clinical epidemiology of atrial fibrillation in Asia","volume":"152","author":"Bai","year":"2017","journal-title":"Chest."},{"key":"B13","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1111\/imj.14777","article-title":"Admission sodium levels and hospital outcomes","volume":"51","author":"Chi","year":"2021","journal-title":"Int Med J."},{"key":"B14","doi-asserted-by":"publisher","first-page":"e014140","DOI":"10.1161\/JAHA.119.014140","article-title":"Abnormal serum sodium is associated with increased mortality among unselected cardiac intensive care unit patients","volume":"9","author":"Breen","year":"2020","journal-title":"J Am Heart Assoc."},{"key":"B15","doi-asserted-by":"publisher","first-page":"1362","DOI":"10.1002\/cpt.1562","article-title":"Severe hyponatremia is often drug induced: 10-year results of a prospective pharmacovigilance program","volume":"106","author":"Ram\u00edrez","year":"2019","journal-title":"Clin Pharmacol Ther."},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1007\/s00392-021-01853-8","article-title":"Serum sodium and eplerenone use in patients with a myocardial infarction and left ventricular dysfunction or heart failure: insights from the EPHESUS trial","author":"Martens","year":"2021","journal-title":"Clin Res Cardiol."},{"key":"B17","doi-asserted-by":"publisher","first-page":"e0207242","DOI":"10.1371\/journal.pone.0207242","article-title":"The prognosis of heart failure patients: Does sodium level play a significant role?","volume":"3","author":"Abebe","year":"2018","journal-title":"PLoS ONE."},{"key":"B18","doi-asserted-by":"publisher","first-page":"e13581","DOI":"10.1111\/ijcp.13581","article-title":"The prognostic importance of serum sodium levels at hospital discharge and one-year mortality among hospitalized patients","volume":"74","author":"Thongprayoon","year":"2020","journal-title":"Int J Clin Pract."},{"key":"B19","doi-asserted-by":"publisher","first-page":"1746","DOI":"10.1093\/ndt\/gfz098","article-title":"Increased mortality risk associated with serum sodium variations and borderline hypo- and hypernatremia in hospitalized adults","volume":"35","author":"Thongprayoon","year":"2020","journal-title":"Nephrol Dial Transplant."},{"key":"B20","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1016\/j.ejim.2017.07.017","article-title":"Sodium levels on admission are associated with mortality risk in hospitalized patients","volume":"46","author":"Akirov","year":"2017","journal-title":"Eur J Int Med."},{"key":"B21","doi-asserted-by":"publisher","first-page":"e0218504","DOI":"10.1371\/journal.pone.0218504","article-title":"Von Buchwald, et al. Racial differences and mortality risk in patients with heart failure and hyponatremia","volume":"14","author":"Miles","year":"2019","journal-title":"PLoS ONE."},{"key":"B22","doi-asserted-by":"publisher","first-page":"956","DOI":"10.1007\/s00392-018-1268-5","article-title":"Sodium levels during hospitalization with acute myocardial infarction are markers of in-hospital mortality: soroka acute myocardial infarction II (SAMI-II) project","volume":"107","author":"Plakht","year":"2018","journal-title":"Clin Res Cardiol."},{"key":"B23","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1016\/j.hjc.2018.03.006","article-title":"Hyponatremia is associated with occurrence of atrial fibrillation in outpatients with heart failure and reduced ejection fraction","volume":"60","author":"Cavusoglu","year":"2019","journal-title":"Hellenic J Cardiol."},{"key":"B24","doi-asserted-by":"publisher","first-page":"101","DOI":"10.3892\/etm.2020.9231","article-title":"Prognostic value of serum hyponatremia for outcomes in patients with heart failure with preserved ejection fraction: An observational cohort study","volume":"20","author":"Su","year":"2020","journal-title":"Exp Ther Med."},{"key":"B25","doi-asserted-by":"publisher","first-page":"251","DOI":"10.5603\/KP.a2015.0180","article-title":"Clinical characteristics and predictors of one-year outcome of heart failure patients with atrial fibrillation compared to heart failure patients in sinus rhythm","volume":"74","author":"Oziera\u0144ski","year":"2016","journal-title":"Kardiol Pol."},{"key":"B26","doi-asserted-by":"publisher","first-page":"1342","DOI":"10.1016\/j.cjca.2017.08.022","article-title":"Comprehensive update of the Canadian cardiovascular society guidelines for the management of heart failure","volume":"33","author":"Ezekowitz","year":"2017","journal-title":"Can J Cardiol"},{"key":"B27","doi-asserted-by":"publisher","first-page":"m4266","DOI":"10.1136\/bmj.m4266","article-title":"Association between low density lipoprotein and all cause and cause specific mortality in Denmark: prospective cohort study","volume":"371","author":"Johannesen","year":"2020","journal-title":"BMJ."},{"key":"B28","doi-asserted-by":"publisher","first-page":"e007054","DOI":"10.1161\/CIRCHEARTFAILURE.120.007054","article-title":"Prognostic value of secreted frizzled-related protein 5 in heart failure patients with and without type 2 diabetes mellitus","volume":"13","author":"Wu","year":"2020","journal-title":"Circ Heart Fail."},{"key":"B29","doi-asserted-by":"publisher","first-page":"1834","DOI":"10.1016\/j.amjcard.2014.03.017","article-title":"Prognostic significance of hyponatremia among ambulatory patients with heart failure and preserved and reduced ejection fractions","volume":"113","author":"Bavishi","year":"2014","journal-title":"Am J Cardiol."},{"key":"B30","doi-asserted-by":"publisher","first-page":"3388","DOI":"10.1016\/S0006-3495(03)74758-4","article-title":"Na\/Ca exchange and Na\/K-ATPase function are equally concentrated in transverse tubules of rat ventricular myocytes","volume":"85","author":"Despa","year":"2003","journal-title":"Biophys J"},{"key":"B31","doi-asserted-by":"publisher","first-page":"781","DOI":"10.1016\/j.hrthm.2015.12.005","article-title":"Electrolyte disturbances differentially regulate sinoatrial node and pulmonary vein electrical activity: a contribution to hypokalemia- or hyponatremia-induced atrial fibrillation","volume":"13","author":"Lu","year":"2016","journal-title":"Heart Rhythm"},{"key":"B32","doi-asserted-by":"publisher","first-page":"122","DOI":"10.1016\/j.hjc.2019.03.012","article-title":"Hyponatremia in patients with atrial fibrillation and heart failure: the difficult triangle","volume":"60","author":"Oikonomou","year":"2019","journal-title":"Hellenic J Cardiol."},{"key":"B33","doi-asserted-by":"publisher","first-page":"1637","DOI":"10.1210\/clinem\/dgab107","article-title":"Dysnatremia is a predictor for morbidity and mortality in hospitalized patients with COVID-19","volume":"106","author":"Tzoulis","year":"2021","journal-title":"J Clin Endocrinol Metab"},{"key":"B34","doi-asserted-by":"publisher","first-page":"599255","DOI":"10.3389\/fendo.2020.599255","article-title":"Prognostic impact of hyponatremia and hypernatremia in COVID-19 pneumonia. a HOPE-COVID-19 (health outcome predictive evaluation for COVID-19) registry analysis","volume":"11","author":"Ruiz-S\u00e1nchez","year":"2020","journal-title":"Front Endocrinol."},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.1097\/ccm.0000000000005173","article-title":"Association between an increase in serum sodium and in-hospital mortality in critically Ill patients","author":"Grim","year":"2021","journal-title":"Crit Care Med."},{"key":"B36","doi-asserted-by":"publisher","first-page":"913","DOI":"10.1097\/00003246-198610000-00020","article-title":"Influence of hypernatremic-hyperosmolar state on hemodynamics of patients with normal and depressed myocardial function","volume":"14","author":"Lenz","year":"1986","journal-title":"Crit Care Med."},{"key":"B37","doi-asserted-by":"publisher","first-page":"1028","DOI":"10.2337\/diab.32.11.1028","article-title":"Impairment of insulin-mediated glucose metabolism by hyperosmolality in man","volume":"32","author":"Bratusch-Marrain","year":"1983","journal-title":"Diabetes."},{"key":"B38","doi-asserted-by":"publisher","first-page":"e5387","DOI":"10.7759\/cureus.5387","article-title":"Correction of hypernatremia due to pure dehydration could be a potential risk factor for transient atrial fibrillation","volume":"11","author":"Timilsina","year":"2019","journal-title":"Cureus"},{"key":"B39","doi-asserted-by":"publisher","first-page":"668","DOI":"10.1161\/01.CIR.0000086979.39843.7B","article-title":"Intra-atrial pressure increases rate and organization of waves emanating from the superior pulmonary veins during atrial fibrillation","volume":"108","author":"Kalifa","year":"2003","journal-title":"Circulation"}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2022.963103\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,10,12]],"date-time":"2022-10-12T09:11:22Z","timestamp":1665565882000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2022.963103\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,12]]},"references-count":39,"alternative-id":["10.3389\/fcvm.2022.963103"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2022.963103","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,10,12]]},"article-number":"963103"}}