Isolating the benefits of fluid restriction in patients with heart failure: A pilot study

• Type of Material: Article
• Authors: Carolyn Miller Reilly, Emory University; Melinda K Higgins, Emory University; Andrew L Smith, Emory University; Steven D Culler, Emory University; Sandra B Dunbar, Emory University
• Language: English
• Date: 2015-12-01
• Publisher: SAGE Publications
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2015 European Society of Cardiology.
• Final Published Version (URL): http://dx.doi.org/10.1177/1474515114541729
• Title of Journal or Parent Work: European Journal of Cardiovascular Nursing
• ISSN: 1474-5151
• Volume: 14
• Issue: 6
• Start Page: 495
• End Page: 505
• Grant/Funding Information: The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.; Study Supported by the NIH/ NINR NRSA 5F32 NR010451-02 (C.M. Reilly, PI), Interdisciplinary Pilot Research Grant NIH/NINR P20 NR007798, the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number UL1TR00045; and Biosite, Inc. Grant In Aid of equipment and supplies.
• Keywords: SALT; self-care; SODIUM; Cardiovascular System & Cardiology; heart failure; Fluid restriction; THIRST; DRINKING; QUALITY-OF-LIFE; TRIAL; Science & Technology; Nursing; THERAPY; Life Sciences & Biomedicine; CONGESTION SCORE; thirst; SELF-CARE; symptoms; OUTCOMES; Cardiac & Cardiovascular Systems
• Research Categories: Health Sciences, Public Health; Health Sciences, Medicine and Surgery

Abstract

Background: Fluid restriction (FR) in persons with heart failure (HF) is often prescribed, yet self-regulation and the troublesome symptom of thirst are difficult for patients to manage. Aims: The purpose of this pilot study was to test an educational and behavioral intervention (EBI) on adherence with prescribed FR and outcome measures of fluid congestion, symptom distress, and health related quality of life (HRQL). Secondary aims were to describe the relationships between self-reported and objectively measured determinants of fluid status and symptoms, and assess the psychometric properties of piloted instruments, and intervention effect sizes. Methods: NYHA Class II-IV (n=25, 44-83 years, 56% male, 20% minority, mean EF 23.0+11.7%) participants were randomized to the EBI or attention control (AC) and evaluated at baseline, 3 and 6 months. Results: EBI patients trended toward decreasing fluid ingestion (p=0.08), experienced less HF symptom frequency (p=0.13) and severity (p=0.06), and increased symptoms of thirst (p < 0.01) across time. Whereas HRQL remained stable in the EBI group, it improved in the AC group over time (p=0.01). There were no significant differences in clinical measures of fluid congestion between groups. Conclusions: These outcomes suggest that patients receiving the EBI drank slightly less fluid, experienced less typical HF symptoms, greater thirst distress and stable HRQOL. Moderate to large effect sizes for the measures used were observed, and outcomes suggest that a randomized trial of various levels of FR would not potentiate fluid congestion but should specifically address preservation of HRQOL and thirst symptoms.