Fluid Restriction Does Not Improve outcomes in Chronic HF.
Fluid Restriction Does Not Improve outcomes in Chronic HF.
Source: ACC.25 Scientific Session,
Date: April 1, 2025
Summary of Fluid Restriction in Heart Failure vs. Liberal Fluid Uptake – FRESH-UP trial :
1. Background:
• Fluid restriction is commonly recommended for chronic heart failure (HF) patients, though evidence from randomized controlled trials (RCTs) has been limited.
• The potential negative impact on quality of life (QoL) and patient comfort is a concern.
2. Study Design – FRESH-UP Trial:
• Multicenter, open-label RCT in the Netherlands.
• 504 patients with NYHA class II–III chronic HF symptoms.
• Randomized to:
• Liberal fluid intake,
• Or fluid restriction (1.5 L/day) for 3 months.
• Primary endpoint: QoL via KCCQ-OSS (Kansas City Cardiomyopathy Questionnaire – Overall Summary Score).
• Secondary endpoint: Thirst distress via Thirst Distress Scale for HF (TDS-HF).
• Safety endpoints: Mortality, HF hospitalization, IV diuretic use at 3 and 6 months.
3. Main Results:
• Quality of Life (KCCQ-OSS):
• Liberal group: 74.0 (95%CI: 71.5–76.6)
• Fluid restriction: 72.2 (95%CI: 69.6–74.7)
• Mean difference: +2.17 points (95%CI: –0.06 to 4.39; P=0.06) — not statistically significant.
• Thirst Distress (TDS-HF):
• Higher in fluid restriction group: 18.6 vs. 16.9 — P<0.001
• Safety outcomes:
• No significant differences in mortality, hospitalization, or diuretic use at 6 months (all P>0.05)
4. Conclusion:
• Restricting fluid intake to 1.5 L/day in chronic HF did not improve QoL.
• Patients experienced significantly more thirst.
• No safety concerns were identified.
• The study challenges the clinical benefit of fluid restriction in chronic HF management.