Whether sodium and fluid restriction help reduce exacerbations and readmissions for patients with heart failure: An integrative review

Heart failure (HF) is a chronic medical condition which is becoming increasingly prevalent around the world. This condition is linked to poor quality of life (QOL) due to the impact it has on patients functional status and mental health. There have been several advancements in the care and management of patients with HF with little change to self-care interventions resulting. Two self-care interventions which are recommended throughout clinical guidelines are a sodium restriction and a fluid restriction which are widely used and encouraged through patient education. Research, however, has questioned their validity and demonstrating a lack of evidence on improved outcomes. In order to determine whether there should be changes to current practice, an integrative review has been completed. The aim is to assess whether these self-care interventions improve outcomes for patients with HF. From this review themes identified include a lack of robust data, the potential harm of interventions, and various outcomes extending beyond HF exacerbations and readmissions. There appears to be a lack of recent data on the impact of a fluid restriction as an independent variable. However, there are noted improvements in a variety of outcomes from both interventions outside of hospital readmissions which demonstrates they are valuable. Given these findings there is not enough evidence to remove restrictions but there are recommendations which can be made to modify current practice. These recommendations include to liberalizing sodium and fluid restrictions and making restrictions more specific to the severity of HF for patients going forward.