Limiting fluid does not improve health in patients with heart failure

People with heart failure have long been recommended to reduce the amount of fluid they consume each day to help reduce the congestion or accumulate fluids in the lungs and limbs, but this advice does not provide benefits, in accordance with the study presented at the annual Arman College of Cardiology scientific session (ACC.25).

Heart failure occurs when the heart becomes too stiff or too weak to effectively pump the blood throughout the body. Overload is a common symptom that can cause swelling and shortness of breath. To reduce this, American and European medical guidelines recommend limiting daily fluid intake to about six cups (1500 milliliters). However, there is a lack of evidence for this recommendation, and experts debated whether it is necessary to limit fluid consumption.

This study is the first large randomized controlled study assessed how liberal and limited fluid intake affect health in patients with heart failure. The results showed a tendency to improve health for people with unlimited fluid intake, but the difference between test groups was not statistically important for the first end point of the study. The desire was higher in people with liquid limitation, while no difference in any of the exploratory safety results.

Our conclusion is that in patients with stable heart failure there is no need to reduce fluid. This is an important news for patients with heart failure around the world and can be implemented immediately. “

Roland van Kimmenade, MD, cardiologist at the Radboud University Medical Center in Nijmegen, the Netherlands and the elder author of Study

The process, called Fresh-up, was written by 504 people with heart failure in seven medical centers in the Netherlands. The participants of the study were on average 69 years old, about two -thirds were men, and everyone had heart failure with mild to moderate symptoms, but they felt comfortable at rest. About half of the participants had heart failure with a reduced ejection fraction, and half retained the ejection fraction, representing two types of heart failure. Most of the participants took standard drugs for heart failure, and about half took diuretic loops, a kind of drug that helps in coping with swelling and fluid retention.

Half of the participants were assigned to limit the daily consumption of fluid to 1500 ml, and half was instructed to drink as much as they wanted. After three months, scientists assessed the participants’ health with Kansas City Cardiomyopathy Questionnaire (KCCQ) and did not find a statistically significant difference between groups.

Scientists have found that several factors could have influenced the results. One of the unforeseen discoveries was that about half of the patients was not recommended to limit fluid consumption before signing up for the test. Secondly, the participants had higher results for their health at the beginning than expected. Considering that the studied population had a relatively high initial health, and many were already in the diagram of liberal fluid consumption, the study was difficult to show significant benefit from liberal fluid consumption compared to fluid limitation. According to scientists, this could lead to the insignificant results of the original result.

In general, the difference in consuming fluid between two groups was relatively small. Patients assigned to limit fluids used an average of 1,480 ml per day, and patients assigned to unlimited fluid consumption used an average of 1,760 ml per day, an average difference of less than 10 ounces. Participants assigned to reduce fluid intake reported a greater desire. Importantly, there were no differences between groups in terms of death, hospitalization of heart failure, the need for intravenous diuretics or acute kidney damage after six months.

“We have not found any signal in primary results or security that limiting fluids contributes to everything or that liberal fluid intake would lead to any damage,” said Van Kimmenade. “Therefore, our results question the need to reduce fluid in patients with stable heart failure.”

Although the study was conducted in one country, scientists found that the results would be generalized in other developed countries in which some clinicians routinely advise fluid limiting in patients with heart failure, while others do not.

The study was financed by Dutch Heart Foundation and Grant Radboud UMC /Maastricht UMC.

This study was simultaneously published online at the time of presentation.