Major points

1. The purpose of water control for heart failure patients is to reduce the burden on the heart and reduce re-hospitalization.
2. Daily water should be limited within 1500~1800mL. Daily salt intake should be less than 5 grams (approximately = 1 teaspoon of salt = 6 teaspoons of soy sauce or dark vinegar = 12 teaspoons of ketchup).
3. Measure your body weight every morning when you wake up and record your intake and output.
    

What is heart failure?

Heart failure is commonly known as " heart dysfunction." It refers to a disorder of cardiac structure or function, causing insufficient cardiac output for body requirement.
 

What are the common symptoms of heart failure?

Heart failure patients may have symptoms of decrease urinary output, low legs edema, headache, nausea, cough, fatigue and weakness due to insufficient cardiac output.

Principles of care:

Heart failure patients should be recommended treatment including medication, cardiac rehabilitation, diet and water control. The purpose of water control for heart failure patients is to reduce the burden on the heart and reduce the rate of re-hospitalization. The following water control matters requires attention.

1. Each patient would be limited the amount of fluid intake every day (about 1,500 to 1,800 c.c.). Daily Water Intake =Total Output of the day before (including urine, vomiting, defecation volume or drainage)+ 500 ~ 700 cc.
2. The resources of water includes the fluid and food.
   1. The amount of water can include your daily drinking water, beverages, and soup, other foods that contain fluid, or nasogastric tube feeding or nutritional drinks, and intravenous fluid.
   2. The water in solid food:The water content of food can refer to the Taiwan Food and Drug Administration database, suggesting the food with low water content, and taking the priority to the more solid food. The vegetables and fruit usually are with high water content.
3. Avoiding taking preserved processed food, in order not to getting thirsty.
4. Taking low-salt diet. The daily salt intake should be less than 5 grams, about 1 teaspoon of salt = 6 teaspoons of soy sauce or dark vinegar = 12 teaspoons of ketchup. When cooking, you can season the food with vegetable oil, scallions, or garlic to improve the taste.
5. When you feel thirsty, you can use cotton swab or lip balm to keep your lips moist. Spit out the water after rinsing your mouth or chew sugar-free gum or suck on ice-cubes until it slowly melt.
6. Recommendation for fluid intake distribution per day: 7 a.m.to 3 p.m.: 50%; 3 p.m.to 11 p.m.: 40%; 11 p.m.to next day 7 a.m.:10%. For example, fluid restriction 1500 ml/day, 7 a.m.to3 p.m. take 750 ml; 3 p.m. to 11 p.m. take 600 ml; 11 p.m. to next day 7 a.m. take 150 ml.
7. Measuring body weight when you first get up in the morning. Bring the records to your doctor at OPD. The right way to weigh: weigh yourself after you urinate, wearing the same amount of clothing and write down your weight every day. If you gain 1 kg in1 day or more than 2 kg in 3 days and occur the shortness of breath, chronic cough and peripheral edema, please return to the hospital right away.
8. Always use a urinal bottle with scale to measure the amount of urine.
    

References

1. Baman, J. R., & Ahmad, F. S. (2020). Heart failure. JAMA, 324(10), 1015. https://doi.org/10.1001/jama.2020.13310
2. Eng, S.-H., Jaarsma, T., Lupón, J., González, B., Ehrlin, J., Díaz, V., Bayes-Genis, A., & Waldréus, N. (2021). Thirst and factors associated with frequent thirst in patients with heart failure in Spain. Heart & Lung, 50(1), 86-91. https://doi.org/10.1016/j.hrtlng.2020.08.002
3. McDonagh, T., Metra, M., Adamo, M., Gardner, R., Baumbach, A., Böhm, M., Burri, H., Butler, J., Celutkiene, J., Chioncel, O., Cleland, J., Coats, A., Crespo-Leiro, M., Farmakis, D., Gilard, M., Heymans, S., Hoes, A., Jaarsma, T., Jankowska, E., Mebazaa, A., & Heymans, S. (2021). 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: developed by the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) with the special contribution of the Heart Failure Association (HFA) of the ESC. European Heart Journal, 42, 3599-3726. https://doi.org/10.1093/eurheartj/ehab368
4. Shen, Z., Zhang, Y., Yang, C., Liu, J., Huang, C., Zhang, X., Zhang, Y., & Lin, Y. (2022). A smart-phone app for fluid balance monitoring in patients with heart failure: a usability study. Patient preference and adherence, 16, 1843–1853. https://doi.org/10.2147/PPA.S373393
5. Thapa, K., Das, S., Pathak, P., & Singh, S. (2021). Assessment of thirst intensity and thirst distress and the practices for its management among heart failure patients admitted to the cardiology unit. Journal of the Practice of Cardiovascular Sciences, 7(1), 36-40. https://doi.org/10.4103/jpcs.jpcs_8_21