Heart failure & cardiomyopathiesSecondary analysis
The effect of a change in fluid intake advice on outcomes in chronic heart failure: a prespecified subanalysis of the FRESH-UP study
- prespecified subanalysis of the FRESH-UP study
- open-label
- randomized
Authors' conclusion
These analyses add understanding to the effects of fluid intake management in chronic HF and expose a signal of potential harm of FR in patients with pre-trial LFI and a potential benefit of LFI in patients with pre-trial FR. These results corroborate with the primary results and support that there is no need to routinely initiate or continue FR in stable patients with chronic HF.
Study context
- Population
- Patients with chronic heart failure (HF), stratified according to pre-trial fluid management (fluid restriction (FR) or liberal fluid intake (LFI))patients randomized · pre-trial FR 269 (53.4%) · pre-trial LFI 235 (46.6%)
- Participants
- 504 patients
- Comparison
- liberal fluid intake vs fluid restriction
- Primary endpoint
- Kansas City Cardiomyopathy Questionnaire Overall Summary Score (KCCQ-OSS) adjusted for baseline
- Follow-up
- 3 months
Primary result
As reported in the abstract
pre-trial FR to LFI
74.7
95% CI 71.2–78.3
pre-trial LFI to FR
70.2
95% CI 66.3–74.2
- Kansas City Cardiomyopathy Questionnaire Overall Summary Score (KCCQ-OSS) significantly different between groups
- P = 0.035
Secondary outcomes
Patient-reported fluid intake · Week 6
- Patient-reported fluid intake — significantly higher in patients randomized to LFI when compared to FR
- P = .019
Thirst distress (key secondary outcome)
- thirst distress increased the most in patients changing from pre-trial LFI to FR
Safety
Death and hospitalizations
- Safety outcomes did not differ
Original publication
The effect of a change in fluid intake advice on outcomes in chronic heart failure: a prespecified subanalysis of the FRESH-UP study. ESC Heart Fail. Published 29 July 2026. doi:10.1093/eschf/xvag197
Summarised from the published abstract; every number is checked against it