What is the clinical evidence from this study?

Study design: Observational. Population: Heart Failure (n=66). Intervention: Heart failure medical therapy optimization. Primary outcome: Change in thirst intensity (OR 6.25, 95% CI 95% CI 1.90–20.5, p=<0.001).

December 22, 2015The Journal of Cardiovascular NursingOpen Access

Changes in Thirst Intensity During Optimization of Heart Failure Medical Therapy by Nurses at the Outpatient Clinic

Q: What are the key findings of this study?

Thirst intensity increased in 67% of heart failure patients during the up-titration of HF medication, with fluid restriction associated with high thirst intensity (OR 6.25).

Q: What does this research mean for the field?

Thirst intensity increased in 67% of heart failure patients during the up-titration of HF medication, with fluid restriction associated with high thirst intensity (OR 6.25). Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

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Key result

Fluid restriction is linked to ~6-fold higher odds of intense thirst during HF medication up-titration.

OR 6.25
95% CI 1.90–20.5
P<0.001
n=66

Why the study?

Does up-titration of heart failure medication improve thirst intensity in patients with heart failure?

Population

66 patients with heart failure referred to an outpatient HF clinic for up-titration of HF medication. Mean…

Design

Cohort

Follow-up

median 43 days

Authors

NWNana WaldréusHeart Failure & Transplant RHRobert G. HahnHeart Failure & Transplant PLPatrik LyngåKarolinska Institutet

Discussion

Member takes

Implication

Thirst may worsen during HF up-titration; hypothesis-generating for fluid management trials before practice change.

Study Design

Type

Observational (n=66)

Multicenter

Yes

Structured PICO

Does up-titration of heart failure medication improve thirst intensity in patients with heart failure?

Population

66 patients with heart failure (mean LVEF ≤50%, age ≥60 years) referred to an outpatient HF clinic for up-titration of HF medication. Mean age 73, 83% male, Sweden. Excluded: type 1 diabetes, insulin-treated type 2 diabetes, advanced kidney disease with dialysis, palliative care, and pulmonary disease treated with oxygen.

Intervention

Up-titration of heart failure medication (RAAS blockers, beta-blockers) and heart failure education by nurses at an outpatient clinic over a median of 43 days.

Outcome

Changes in thirst intensity (measured by a 100 mm visual analog scale) from baseline to the end of the up-titration program, and factors associated with high thirst intensity (>20 mm).patient reported

Main Result

Effect estimate: OR 6.25 (95% CI 95% CI 1.90–20.5)

p-value: p=<0.001

Optimization of heart failure medication does not alleviate thirst, which actually increases in most patients and is strongly driven by fluid restriction and higher plasma urea levels.

Limitations

The majority of participants were male, limiting generalizability to female patients.
Short up-titration period may not accurately reflect long-term neuroactivation effects.
No definitive cut-off for 'high' vs 'low' thirst intensity exists, using median may complicate comparisons.
Majority of participants were men, limiting generalizability
No standard cut-off value for low and high thirst intensity in HF patients, necessitating use of the sample median
Not all patients reached target doses of HF medication
Short up-titration period
Relied on self-reported restricted fluid volume rather than true fluid intake

Cite This Study

Waldréus et al. (2015) conducted an observational in Heart Failure (n=66). Heart failure medical therapy optimization was evaluated on Change in thirst intensity (OR 6.25, 95% CI 95% CI 1.90–20.5, p=<0.001). Thirst intensity increased in 67% of heart failure patients during the up-titration of HF medication, with fluid restriction associated with high thirst intensity (OR 6.25).

synapsesocial.com/papers/696b83063d9324fa0eadb425 https://doi.org/10.1097/jcn.0000000000000319

Topics

HFrEF treatment Heart failure

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Changes in Thirst Intensity During Optimization of Heart Failure Medical Therapy by Nurses at the Outpatient Clinic

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Topics

Changes in Thirst Intensity During Optimization of Heart Failure Medical Therapy by Nurses at the Outpatient Clinic

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Topics

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