Description of self-reported fluid intake and its effects on body weight, symptoms, quality of life and physical capacity in patients with stable chronic heart failure

Aim. To describe the self-reported fluid intake and its effects on body weight, signs and symptoms of heart failure, quality of life, physical capacity and thirst, in patients with stabilised chronic heart failure. Background. Patients with chronic heart failure are often recommended a fluid restriction of 1.5 l/day but there is no evidence in the literature for this recommendation and little is known about the fluid intake consequences. Design. Crossover study. Methods. Chronic heart failure patients, clinically stabilised after an unstable state, were randomised to a 32-week cross-over study assessing the clinical importance of fluid prescription. In a secondary analysis of 63 patients, efficacy variables were analysed in relation to the self-reported median fluid intake of 19 ml/kg body weight/day. Results. The mean fluid intake was 16 ml/kg/day in the below-median group and 24 ml/kg/day in the above-median group. No between-group differences were found in change in body weight, signs and symptoms, diuretic use, quality of life or physical capacity. However, the above-median group significantly decreased sense of thirst and difficulties to adhere to the fluid prescription compared with the below-median group. Conclusion. In clinically stabilised chronic heart failure patients on optimal pharmacological treatment, a larger fluid intake was associated with decreasing thirst without any measurable negative effects on signs and symptoms of heart failure, diuretic use or physical capacity. Thus, a more liberal fluid intake may be advisable in chronic heart failure patients who have been stabilised after an initial unstable clinical state. Relevance to clinical practice. Nurses involved in the care for patients with heart failure known how troublesome thirst can be and how difficult it can be to follow a restricted fluid intake. This study indicates that it is possible to reassess and recommend a less strict fluid intake in stabilised patients with chronic heart failure.