[Evidence-based practice of fluid restriction in patients with heart failure].

Heart failure (HF) is prevalent in the aging population. Both pharmacological and non-pharmacological therapies are employed in HF and have yielded significant improvements in survival and quality of life. Body fluid must be maintained at a level sufficient to ensure hemodynamic stability and adequate tissue perfusion, which may decrease neurohormonal activation caused by low cardiac output in patients with HF. However, shortness of breath and peripheral edema caused by fluid overload remain the most common clinical symptoms of HF, causing patient distress. In addition to routine pharmacologic approaches, fluid restriction is frequently suggested in HF management strategies. The purpose of this review of published studies that examined use of fluid/water restriction as an intervention was to determine the optimal fluid intake for HF patients in clinical practice. Four articles describing three clinical trials were identified via PubMed and CINAHL. Their findings suggest that patients with clinically stable HF receiving optimal pharmacological treatment may not benefit from fluid restriction. Patients in these studies had preserved renal function, however, and the trials had no long-term follow-up period. Clinicians choosing to restrict fluid intake for patients with HF should consider an individualized fluid prescription, potentially based on patient body weight, sodium intake, and likelihood of adherence. Further clinical trials are warranted to improve clinical practice in caring for patients with HF.