Heart failure & cardiomyopathiesMeta-analysis
Fluid restriction in patients with heart failure: a systematic review
- systematic review
Authors' conclusion
Studies on fluid restriction in patients with HF are scarce, and most of the available studies are at high risk of bias. Although power is lacking, there is no evidence indicating that fluid restriction affects mortality or HF hospitalisations, but there is a signal of harm in terms of thirst distress. Taken together, the current evidence does not support the routine use of fluid restriction in patients with HF.
Study context
- Population
- Adults with heart failure (HF) randomised to fluid restriction in comparison to a liberal or unrestricted intake, less strict restriction or usual carerandomised inpatient, recently discharged and stable outpatient patients in four randomised clinical trial (RCTs) (ranging from 46 to 504 patients per trial)
- Participants
- 682 adults
- Comparison
- fluid restriction in comparison to a liberal or unrestricted intake, less strict restriction or usual care
Pooled result
As reported in the abstract
Mortality and HF hospitalisations
- None of the four trials found a significant difference in mortality or HF hospitalisations
Further pooled results
Quality of life (QoL)
- Results contradictory; overall no clear benefit for fluid restriction
New York Heart Association (NYHA) class and (NT-pro)BNP
- No significant differences in NYHA class or (NT-pro)BNP were observed
Conduct of the review
- Only one study had a low risk of bias
- No meta-analysis was performed due to high heterogeneity of the included trials
Original publication
Fluid restriction in patients with heart failure: a systematic review. Heart. Published 13 January 2026. doi:10.1136/heartjnl-2025-326784
Summarised from the published abstract; every number is checked against it