Salt and fluid restriction is effective in patients with chronic heart failure

Aims European and American guidelines have recommended salt and fluid restriction for patients with chronic heart failure (CHF) despite scarce scientific evidence. Therefore, we investigated the effects of salt and fluid restriction in patients with CHF. Methods and results Ninety‐seven stable patients in NYHA class II–IV, on optimal medication, with previous signs of fluid retention, treated with either >40 mg (NYHA III–IV) or >80 mg (NYHA II–IV) of furosemide daily were randomized to either individualized salt and fluid restriction or information given by the nurse‐led heart failure clinics, e.g. be aware not to drink too much and use salt with caution, and followed for 12 weeks. Fluid was restricted to 1.5 L and salt to 5 g daily, and individualized dietary advice and support was given. The 24 h dietary recall procedure, urine collection on three consecutive days, and para‐aminobenzoic acid 80 mg t.i.d. was used to assess adherence to diet and completeness of urine collection. The primary endpoint was a composite variable consisting of NYHA class, hospitalization, weight, peripheral oedema, quality of life (QoL), thirst, and diuretics. Results After 12 weeks, significantly more patients in the intervention than in the control group improved on the composite endpoint (51% vs. 16%; P < 0.001), mostly owing to improved NYHA class and leg oedema. No negative effects were seen on thirst, appetite, or QoL. Conclusion Individualized salt and fluid restriction can improve signs and symptoms of CHF with no negative effects on thirst, appetite, or QoL in patients with moderate to severe CHF and previous signs of fluid retention.