People with heart failure have long been advised to limit the amount of fluids they consume every day to help reduce congestion or accumulation of fluids in the lungs and limbs, but these tips do not provide any benefits, according to a study presented at the ACC.
Heart failure occurs when the heart becomes very rigid or too weak to effectively pump blood throughout the body. Concerning is a common symptom that can cause swelling and shortness of breath. To reduce this, American and European medical guidelines are to limit daily fluid intake to about six cups (1,500 milliliters). However, evidence for this recommendation is missing and experts have discussed whether limiting fluid intake is necessary.
This study is the first major randomized controlled test to evaluate how liberal against limited fluid intake affects the state of health in patients with heart failure. The results showed a tendency for improved health status for those with unlimited fluid intake, but the difference between study groups was not statistically significant for the main end point. The thirst was higher in those with fluid restriction, and there was no difference in any of the investigative safety results.
Our conclusion is that in patients with constant heart failure there is no need for fluid reduction. This is an important message for patients with heart failure around the world and can be applied immediately. ”
Roland Van Kimmenade, MD, Cardiologist at Radboud University Medical Center in Nijmegen, the Netherlands and the Senior author of the study
The test, called Fresh-Up, was recorded 504 people with heart failure in seven medical centers in the Netherlands. The study participants were 69 years old on average, about two -thirds were men and everyone had heart failure with mild to moderate symptoms, but were comfortable at rest. About half of the participants had heart failure with a reduced extrusion fraction and half had maintained an extrusion fraction, representing the two types of heart failure. Most participants received typical heart failure drugs and about half received diuretics loop, a kind of drug that helps manage swelling and fluid retention.
Half of the participants were commissioned to limit the daily intake of fluid to 1,500 ml and half received instructions to drink as much as they wanted. In three months, the researchers evaluated the health status of the participants using the Kansas City (KCCQ) questionnaire and found no statistically significant difference between the groups.
Researchers said that several factors may have affected the results. An unpredictable finding was that about half of the patients had not advised to limit fluid intake before being enrolled in the study. Secondly, participants had higher health ratings at the start of the expected. Since the population of the study had a relatively high state of basic health and many were already in a form of liberal fluid intake, it was difficult for the study to prove a significant benefit from recruiting liberal fluids over fluid limitation. According to the researchers, this may have led to the non -significant effects of the primary result.
Overall, the difference in fluid intake between the two groups was relatively moderate. Patients assigned to a fluid restriction average 1,480 ml daily and those assigned to unlimited fluid intake consumed an average of 1,760 ml daily, an average difference of less than 10 ounces. Participants assigned to limit their fluid intake reported more thirst. It is important that there were no differences between groups in death, heart failure, the need for intravenous diuretic or acute kidney damage in six months.
“We have found no signal in the main results or results of safety that limiting fluids contributes to anything or that liberal fluid intake would lead to any damage,” Van Kimmenade said. “Consequently, our effects question the need for fluid limitation in patients with stable heart failure.”
Although the study was carried out in a single country, the researchers said the findings would probably be generalized in other developed countries, where some clinicians usually advise fluid limitation for patients with heart failure and others do not.
The study was funded by the Heart Dutch Foundation and the UMC /Maastricht UMC UMC grant.
This study was published simultaneously on the internet at Natural medicine at the time of the presentation.
Source:
Magazine report:
Herrmann, JJ, et al. (2025). Liberal fluid intake against fluid limitation in chronic heart failure: randomized clinical trial. Natural medicine. Doi.org/10.1038/S41591-025-03628-4.
