Although there is little evidence on the importance of fluid and sodium restriction in heart failure (HF) patients, recent ESC guidelines recommend that HF patients should avoid excessive fluid intake and excessive salt intake of > 6 gram (= 2400 mg sodium). A fluid restriction of 1500-2000 ml might be considered in patients with severe HF to relieve symptoms and congestion. However, it is unknown which advices are provided to HF patients in daily practice at the HF clinic.
Therefore, the purpose of this study was to describe the practice of HF nurses regarding fluid restriction and sodium restriction to stable patients who visit a HF clinic.
A total of 186 HF nurses in the Netherlands were invited to participate in a survey by e-mail. They were asked to fill in a 10-item questionnaire about recommendations regarding sodium and fluid intake for stable patients visiting the HF clinic. They also were asked the rationale for their advice. Finally, they were asked who in their HF team decides about the amount of sodium and fluid restriction?
A total of 98 HF nurses (response rate 53%) filled in the questionnaire (mean age 49±9; 93% women) Most of the HF nurses (69%) recommend standard a fluid restriction ranging from 1500 to 2000 ml in stable HF patients and 12% of nurses advice their patients in general to drink a maximum of 1500 ml. In total 42% of the nurses reported that the rationale of their advice was based on recent guidelines. They also reported that their advice was adapted based on New York Heart Association functional class (24%) or Left Ventricular Ejection fraction (6%). Regarding sodium restriction, 43% of nurses recommend their patients to restrict their sodium intake to a maximum of 2400 mg sodium, 13% reported advising to reduce their intake to 2000 mg sodium and 18% recommended not to add salt to the meal. Nurses reported to base their advice mainly on recent HF guidelines (63%).
Most of the time, the HF nurse decides about fluid restriction (65%) and sodium restriction (69%), or the decision is made together with the cardiologist or the HF team.
Many nurses in the Netherlands advice their stable HF patients to restrict their fluid intake and their sodium intake to a max 2400 sodium a day. In most of the cases, the HF nurse decides about the amount of fluid intake, sometimes together with the cardiologist.
To implement the recent HF guidelines in daily practice with regard to non pharmacological advice, additional training might be needed.