Abstract Body (Do not enter title and authors here): Background: Although fluid overload is inextricably linked to heart failure (HF), dehydration is also possible in HF patients. Maintaining euvolemia is the cornerstone of HF management. Physicians should find a balance between decongestion therapy and the risk of dehydration. In the absence of enough supportive evidence, the US and European guidelines for the diagnosis and treatment of acute and chronic HF provide only a general recommendation supporting fluid restriction (FR) for selected patients with symptomatic HF, without providing a level of evidence. Thus, we aimed to evaluate the risk of all-cause mortality, hospital readmissions, and change in BNP, sodium, potassium, creatinine, and perceived thirst in HF patients with FR vs liberal fluid intake.
Methods: We performed a systematic literature search on PubMed, EMBASE, and Scopus for relevant randomized controlled trials (RCTs) from inception until May 2024. Risk ratios (RR), weighted mean differences (WMD), and 95% confidence intervals (CI) were pooled using a random-effect model.
Results: A total of 8 RCTs with 767 patients (364 in the FR group and 403 in the non-FR group) were included in the study. The mean age of patients among FR and non-FR groups was 69.49 and 68.62 years, respectively. The mean follow-up duration was 95 days. Pooled analysis of primary and secondary outcomes showed that there are no statistically significant differences between FR and liberal fluid intake in the risk of HF hospital readmissions [RR, 0.64; 95%CI: 0.24-1.70; P=0.37], and all-cause mortality [RR, 0.62;95% CI: 0.31-1.25; P=0.18] (Figure 1). No significant difference in thirst was also observed [WMD: 2.94, 95% CI: -3.61 to 9.48, P=0.38]. For FR, BNP at follow-up showed a non-significant increasing trend (WMD: 21.34, 95% CI: -144.28 to 186.97, P=0.80). Sodium levels showed a non-significant increase in FR vs liberal fluid intake (WMD: 1.94, 95%CI: -1.10 to 4.99, P=0.21). Creatinine and potassium levels showed no significant differences at any time point.
Conclusion: Fluid restriction does not significantly reduce the risk of HF rehospitalizations and all-cause mortality in HF patients. Further randomized controlled trials are warranted to confirm these findings and result in suitable recommendations and clinical practice changes.