Aggressive fluid and sodium restriction in decompensated heart failure with preserved ejection fraction: Results from a randomized clinical trial

Objectives: Sodium and fluid restriction is commonly prescribed for heart failure patients. However, its role in the treatment of heart failure with preserved ejection fraction (HFpEF) remains unclear. The aim of this study was to compare the effect of a diet with sodium and fluid restriction with an unrestricted diet in patients admitted for decompensated HFpEF. Methods: Patients were randomized to a diet with sodium (0.8 g/d) and fluid (800 mL/d) restriction (intervention group [IG]) or an unrestricted diet (control group [CG]) and followed for 7 d or hospital discharge. The primary outcome was weight loss. Secondary outcomes included clinical stability, perception of thirst, neurohormonal activation, nutrient intake, readmission, and mortality rate after 30 d. Results: Fifty-three patients were included (30, IG; 23, CG). The mean ejection fraction was 62% +/- 8% for IG and 60% +/- 7% for CG (P = 0.44). Weight loss was similar in both groups, being 1.6 +/- 2.2 kg in the IG and 1.8 +/- 2.1 kg in CG (P= 0.49) as well as the reduction in the congestion score (IG = 3.4 +/- 3.5; CG = 3.8 +/- 3.4; P = 0.70). The daily perception of thirst was higher in the IG (P = 0.03). Lower energy consumption was seen in the IG (P < 0.001). No significant between-group differences at 30 d were found. Conclusions: Aggressive sodium and fluid restriction does not provide symptomatic or prognosis benefits, but does produce greater perception of thirst, may impair the patient's food intake, and does not seem to have an important neurohormonal effect in patients admitted for decompensated HFpEF. (C) 2018 Elsevier Inc. All rights reserved.