title: A randomized controlled pilot study of outcomes of strict allowance of fluid therapy in hyponatremic heart failure (SALT-HF).
abstract: BACKGROUND
  Currently, fluid restriction recommendations in heart failure (HF) are based on expert opinion. After implementing a 1,000-mL/d fluid restriction for 60 days after discharge, outcomes were examined.
  
  
  RESULTS
  In a randomized controlled design, hyponatremic patients (serum sodium ≤137 mg/dL) received usual care (UC; n = 26) or 1,000 mL/d fluid restriction (n = 20) at discharge. Quality of life (QoL), thirst, difficulty following fluid recommendations, adherence to fluid restriction, HF emergency care, HF rehospitalization, and all-cause death were examined. Mean age was 62.8 ± 12.8 years; 46% were white. There were no differences by group in baseline demographics, comorbidities, and QoL, except that more UC patients had New York Heart Association (NYHA) functional class III/IV status (P = .019). Median [interquartile range] QoL scores were better in the 1,000 mL/d group for symptom burden (83.3 [68.8-91.7] vs 50 [29.2-79.2]; P = .018), total symptoms (77.1 [58.1-91.7] vs 54.2 [30.2-73.9]; P = .022), overall QoL summary (72.6 [52.2-86.3] vs 51.0 [37.7-68.5]; P = .038), and clinical QoL summary (75.5 [57.8-92.9] vs 59.1 [35.7-77.3]; P = .039). There were no group differences in thirst, difficulty adhering to fluid recommendations, adherence to fluid restriction, or health care consumption.
  
  
  CONCLUSIONS
  The 1,000 mL/d fluid restriction led to improved QoL at 60 days after discharge. Future research in a larger more heterogeneous sample is needed.
authors.affiliation: Nursing Research and Innovation, Nursing Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA. albertn@ccf.org
authors.forename: Nancy M
authors.initials: NM
authors.lastname: Albert
authors.forename: Benjamin
authors.initials: B
authors.lastname: Nutter
authors.forename: Jennifer
authors.initials: J
authors.lastname: Forney
authors.forename: Ellen
authors.initials: E
authors.lastname: Slifcak
authors.forename: W H Wilson
authors.initials: WH
authors.lastname: Tang
mesh_terms: D000367:Age Factors; D000368:Aged; D000704:Analysis of Variance; D002423:Cause of Death; D018592:Cross-Over Studies; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D006801:Humans; D007010:Hyponatremia / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data; D010865:Pilot Projects; D011788:Quality of Life; D012016:Reference Values; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D016037:Single-Blind Method; D018709:Statistics, Nonparametric; D015996:Survival Rate; D016896:Treatment Outcome