Key result
A systematic review found a lack of clear evidence for the benefits of sodium or fluid restriction in chronic heart failure, with the limited available studies showing conflicting results.
Why the study?
Heart failure lifestyle management includes dietary recommendations such as salt and fluid restriction, but clear evidence supporting these interventions is lacking.
Does sodium and/or fluid restriction improve clinical outcomes and symptoms in patients with heart failure?
Systematic Review (n=15)
Does sodium and/or fluid restriction improve clinical outcomes and symptoms in patients with heart failure?
There is insufficient and conflicting evidence to routinely recommend strict sodium and fluid restriction in all heart failure patients, suggesting that severe restriction may even be harmful in certain populations.
Caution against routine salt/fluid restriction in HF; leaves open need for definitive RCTs.
The incidence and prevalence of heart failure (HF) is increasing worldwide, leading to high morbidity and mortality. The global management of HF involves lifestyle changes in addition to pharmacological treatments. Changes include exercise and dietary recommendations, mainly salt and fluid restriction, but without any clear evidence. We conducted a systematic review to analyse the degree of evidence for these dietary recommendations in HF. Only randomized controlled trials (RCT), and observational studies in humans were selected. Studies were considered eligible if they included participants with HF and sodium and/or fluid restriction. Publications in languages other than English or Spanish were excluded. We included 15 studies related to sodium or fluid restriction. Nine RCT and six observational studies showed some improvements in symptoms and quality of life and a degree of reduction in new hospitalizations, but the results are based on limited population groups, applying different methodologies, and with different restriction goals. We found a lack of clear evidence of the benefits of sodium/fluid restriction in chronic HF. The evidence is limited to few studies with conflicting results. Randomized clinical trials are needed to fill this gap in our knowledge.
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García-García et al. (2021) conducted a systematic review in Heart failure (n=15). Sodium and/or fluid restriction vs. Unrestricted diet or usual care was evaluated on Symptoms, quality of life, and hospitalizations. A systematic review found a lack of clear evidence for the benefits of sodium or fluid restriction in chronic heart failure, with the limited available studies showing conflicting results.
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