From the Guidelines
For a heart failure patient with an ejection fraction (EF) of 10-15%, fluid restriction should typically be limited to 1.5-2 liters per day. This recommendation is based on the most recent guideline from the American College of Cardiology/American Heart Association 1, which suggests that fluid restriction is commonly prescribed for patients with hyponatremia in acute heart failure, although the evidence in this area is of low quality. The restriction includes all fluids consumed, including water, beverages, soups, and foods with high liquid content. Patients should measure and track their daily fluid intake using a journal or container system. They should distribute fluid intake throughout the day, with smaller amounts in the evening to reduce nighttime symptoms.
Key Considerations
- Monitoring daily weight is essential, with increases of 2-3 pounds in 24 hours potentially indicating fluid retention requiring medical attention.
- This restriction helps prevent volume overload, which would further strain the severely compromised heart.
- The extremely low EF indicates the heart can only pump 10-15% of blood with each contraction, making the heart highly sensitive to excess fluid volume.
- Patients should also follow sodium restriction (usually 2000-2300 mg daily), take prescribed diuretics as directed, and recognize symptoms of worsening heart failure such as increased shortness of breath, swelling, or decreased urine output.
Clinical Context
Although the 2022 AHA/ACC/HFSA guideline 1 notes that fluid restriction has limited-to-no effect on clinical outcomes or diuretic use, the potential benefits of preventing volume overload and reducing congestive symptoms in patients with severe heart failure, as suggested by the 2013 ACCF/AHA guideline 1, support the recommendation for fluid restriction in this patient population.
From the FDA Drug Label
Thereafter, patients could resume or initiate fluid restriction (defined as daily fluid intake of ≤1. 0 liter/day) as clinically indicated.
The amount of fluid restriction for a heart failure patient with an EF of 10-15% is ≤1.0 liter/day as clinically indicated 2.
- Key points:
- Fluid restriction is defined as daily fluid intake of ≤1.0 liter/day
- The decision to restrict fluid intake should be made on a clinical basis
- The provided information does not specify the EF percentage as a factor in determining fluid restriction.
From the Research
Fluid Restriction for Heart Failure Patients
- The amount of fluid restriction for heart failure patients with an ejection fraction (EF) of 10-15% is not directly stated in the provided studies, but some studies suggest tailored fluid restriction based on body weight (30 ml/kg per day) 3.
- A study published in the European journal of heart failure in 2013 found that fluid restriction to 1.5 L daily, in combination with salt restriction to 5 g daily, improved signs and symptoms of chronic heart failure in patients with moderate to severe heart failure and previous signs of fluid retention 4.
- Another study published in Clinical nutrition ESPEN in 2021 found that weight-based fluid restriction is supported as the best way to individualize this non-pharmacological treatment and does not appear to affect nutritional parameters capable of putting patients with heart failure at higher malnutrition risk 5.
- However, the same study found that fluid restriction-based diets are effective in reducing liquid intake but increase individuals' thirst sensation and body weight in comparison to non-fluid restriction diets 5.
- It is also important to note that the use of spironolactone, a mineralocorticoid receptor antagonist, has been shown to improve outcomes in patients with heart failure with reduced ejection fraction (EF) and mid-range EF 6, 7.
Considerations for Fluid Restriction
- Temporary fluid restriction can be considered in decompensated heart failure and/or patients with hyponatremia 3.
- Individualized salt and fluid restriction can improve signs and symptoms of chronic heart failure in patients with moderate to severe heart failure and previous signs of fluid retention 4.
- Education, support, and planned evaluations can increase adherence to temporary fluid restriction 3.