Limiting fluid intake may have no benefit for patients with heart failure (HF), according to findings from the FRESH-UP study presented during a Late-Breaking Clinical Trial session at ACC.25 in Chicago and simultaneously published in Nature Medicine.

In the study, 504 patients at seven medical centers in the Netherlands (mean age 69.2 years, 67.3% men), all with mild or moderate symptoms of HF, were either assigned a daily fluid intake limit of 1,500 mL (n=250) or instructed to drink as much fluid as desired (n=254). The majority of participants (87.1%) had NYHA class II symptoms, and most were taking standard HF medication; 51% were taking loop diuretics. Their median baseline KCCQ Overall Summary Score (KCCQ-OSS) was 77.0.

Results showed that, at three months, there was no between-group significant difference in the primary outcome of health status, as measured by the KCCQ-OSS score (74.0 in the liberal fluid arm vs. 72.2 in the fluid restriction arm). The proportion of patients with clinically meaningful changes in the score (either by +5 or =5 points) did not differ significantly either. There was also no difference in mortality, HF hospitalizations, need for intravenous diuretics or acute kidney injury at six months.

Patients without fluid restriction drank an average of 1,764 mL of fluid compared to 1,480 mL in the restriction arm. Thirst distress was significantly higher in the restriction arm.

"We did not find any signal in the primary or safety outcomes that fluid restriction contributes to anything or that liberal fluid intake would lead to any harm," said senior author Roland van Kimmenade, MD. "Our conclusion is that in patients with stable [HF] there is no need for fluid restriction. This is an important message to [HF] patients all over the world and can be implemented immediately."