Individuals with coronary heart failure have lengthy been suggested to restrict the quantity of fluids they eat every day to assist cut back congestion, or the buildup of fluid within the lungs and extremities, however that recommendation offers no profit, based on a research introduced on the American School of Cardiology’s Annual Scientific Session (ACC.25).
Coronary heart failure happens when the center turns into too stiff or too weak to successfully pump blood all through the physique. Congestion is a standard symptom that may trigger swelling and shortness of breath. To assist cut back this, U.S. and European medical tips advocate limiting every day fluid consumption to about six cups (1,500 milliliters). Nonetheless, proof for this advice is missing and consultants have debated whether or not proscribing fluid consumption is important.
This research is the primary giant randomized managed trial to judge how liberal versus restricted fluid consumption impacts well being standing in sufferers with coronary heart failure. The outcomes confirmed a pattern towards improved well being standing for these with unrestricted fluid consumption however the distinction between research teams was not statistically important for the research’s main endpoint. Thirst was increased in these with fluid restriction, whereas there was no distinction in any of the exploratory security outcomes.
Our conclusion is that in sufferers with secure coronary heart failure there isn’t any want for fluid restriction. This is a vital message to coronary heart failure sufferers all around the world and might be applied instantly.”
Roland van Kimmenade, MD, heart specialist at Radboud College Medical Middle in Nijmegen, Netherlands, and research’s senior creator
The trial, known as FRESH-UP, enrolled 504 individuals with coronary heart failure at seven medical facilities within the Netherlands. Examine contributors had been 69 years outdated on common, about two-thirds had been males, and all had coronary heart failure with gentle to average signs however had been comfy at relaxation. About half of the contributors had coronary heart failure with lowered ejection fraction and half had preserved ejection fraction, representing the 2 sorts of coronary heart failure. Most contributors had been taking customary coronary heart failure medicines and about half had been taking loop diuretics, a sort of drug that helps to handle swelling and fluid retention.
Half of the contributors had been assigned to restrict their every day fluid consumption to 1,500 mL and half had been instructed to drink as a lot as they wished. At three months, researchers assessed contributors’ well being standing utilizing the Kansas Metropolis Cardiomyopathy Questionnaire (KCCQ) and located no statistically important distinction between teams.
Researchers mentioned that a number of elements might have affected the outcomes. One unexpected discovering was that about half of the sufferers had not been suggested to restrict their fluid consumption earlier than enrolling within the research. Second, contributors had increased scores for well being standing at baseline than anticipated. Provided that the research inhabitants had a comparatively excessive baseline well being standing and plenty of had been already on a routine of liberal fluid consumption, it was difficult for the research to reveal a major profit from liberal fluid consumption versus fluid restriction. In response to the researchers, this may increasingly have led to the non-significant outcomes of the first consequence.
General, the distinction in fluid consumption between the 2 teams was comparatively modest. Sufferers assigned to fluid restriction consumed a mean of 1,480 mL per day and people assigned to unrestricted fluid consumption consumed a mean of 1,760 mL per day, a mean distinction of lower than 10 ounces. Members assigned to limit their fluid consumption reported extra thirst. Importantly, there have been no variations between teams by way of dying, coronary heart failure hospitalizations, want for intravenous diuretics or acute kidney harm at six months.
“We didn’t discover any sign within the main or security outcomes that fluid restriction contributes to something or that liberal fluid consumption would result in any hurt,” van Kimmenade mentioned. “Accordingly, our outcomes query the necessity for fluid restriction in sufferers with secure coronary heart failure.”
Though the research was carried out in a single nation, researchers mentioned that the findings would seemingly be generalizable to different developed nations the place some clinicians routinely advise fluid restriction for sufferers with coronary heart failure and others don’t.
The research was funded by the Dutch Coronary heart Basis and a Radboud UMC /Maastricht UMC inter-university grant.
This research was concurrently revealed on-line in Nature Medication on the time of presentation.
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Journal reference:
Herrmann, J. J., et al. (2025). Liberal fluid consumption versus fluid restriction in power coronary heart failure: a randomized medical trial. Nature Medication. doi.org/10.1038/s41591-025-03628-4.
