Physicians' Academy for Cardiovascular Education

Salt and fluid restriction helps elderly patients with chronic heart failure

Literature - Philipson H, Ekman I, Forslund HB et al. - Eur J Heart Fail. 2013 Jun 19


Salt and fluid restriction is effective in patients with chronic heart failure.

 
Philipson H, Ekman I, Forslund HB et al.
Eur J Heart Fail. 2013 Jun 19. [Epub ahead of print]
 

Background

As a non-pharmacological treatment of patients with chronic heart failure (CHF), guidelines recommend dietary salt and fluid restriction [1,2]. There is, however, limited convincing evidence supporting this recommendation [3]. Some studies have shown an adverse outcome of salt and fluid restriction [4,5],  while another showed a favourable effect [6]. Salt and liquid restriction may interfere with eating behaviour and quality of life (QoL). Thus, more information is required on whether salt and fluid restriction improves functional ability without having negative impact on QoL.
A pilot study demonstrated that patients with moderate to severe CHF were able to reduce their sodium and fluid intake without negative consequences for thirst, appetite and QoL [7]. To extend these findings, the authors now evaluated the effect of salt and fluid restriction on a composite endpoint consisting of NYHA class, hospitalisation, body weight, peripheral oedema, QoL, thirst and diuretics. In a 12-week prospective trial, 45 patients were randomised to either an individualised salt and fluid restriction and 45 were advised not to drink too much and to limit salt intake (mean age 75+8 years old).
 

Main results

  • 51% of patients in the interventions and 16% in the control group showed improvement in the primary composite endpoint (P<0.001), which was mostly due to improved NYHA class and reduced oedema. The remaining 49% in the intervention group showed deterioration, as opposed to 84% in the control group.
  • Significant reductions from baseline in urine volumes and urine sodium were seen in the intervention group, as opposed to the control group. Weight, thirst and QoL were not affected by the salt and fluid restrictions.
  • 21 patients of intervention group said during a telephone interview 10-12 months after their last visit that they had modified their diet during the study period, and about half of them said that they had maintained this dietary pattern. 4 out of 13 interviewed patients of the control group said that they had made major dietary changes after the study period.
 

Conclusion

This study provides evidence for the recommendation to restrict salt and fluid, in patients with CHF.
A personalised approach to optimise nutrition counselling contributed to adherence to the new diet without negative impact on QoL. Thus, individualised salt and fluid restrictions were associated with improvement in a combined endpoint comprising hospitalisations, NYHA class, QoL, thirst and clinical parameters of fluid retention in elderly patients with CHF.
 

References

1. Dickstein K, Cohen-Solal A, Filippatos G, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur Heart J 2008;29:2388–2442.
2. Hunt SA, Abraham WT, Chin MH, et al. 2009 Focused update incorporated into theACC/AHA2005 Guidelines
for the Diagnosis and Management of Heart Failure in Adults A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration with the International Society for Heart and Lung Transplantation. J Am Coll Cardiol 2009;53:e1–e90.
3. McMurray JJ, Adamopoulos S, Anker SD, et al. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 2012;14:803–869.
4. Paterna S, Gaspare P, Fasullo S, et al. Normal-sodium diet compared with low-sodium diet in compensated congestive heart failure: is sodium an old enemy or a new friend? Clin Sci (Lond) 2008;114:221–230.
5. Dinicolantonio JJ, Pasquale PD, Taylor RS, Hackam DG. Low sodium versus normal sodium diets in systolic heart failure: systematic review and meta-analysis. Heart 2013;in press.
6. Brannstrom M, Ekman I, Norberg A, et al. Living with severe chronic heart failure in palliative advanced home care. Eur J Cardiovasc Nurs 2006; 5:295–302.
7. Philipson H, Ekman I, Swedberg K, Schaufelberger M. A pilot study of salt and water restriction in patients with chronic heart failure. Scand Cardiovasc J 2010;44:209–214.
 

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