Department of Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden.
Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
ESC Heart Fail. 2022 Aug;9(4):2181-2188. doi: 10.1002/ehf2.13960. Epub 2022 May 12.
One of the bothersome symptoms that heart failure (HF) patients can experience is thirst. There are limited data on the association between thirst and fluid intake and clinical variables. Therefore, the aim of this study was to describe severe thirst in stable HF patients and assess factors related to severe thirst, including actual fluid intake and sodium intake.
The study had a cross-sectional design. Stable HF patients from two HF clinics in the Netherlands were included and assessed thirst by a visual analogue scale ranging from 0 to 100. They also completed questionnaires on thirst distress, self-care behaviour, and HF symptoms. A 3 day food diary was completed to assess actual fluid intake and sodium intake. Finally, patients collected urine for 24 h. Patients were divided into severe and low thirst based on thirst score and thirst distress. T-tests, Mann-Whitney tests, and χ tests were conducted to assess differences between both groups. Multivariable logistic regression analysis was performed to assess factors associated with severe thirst. A total of 100 patients were included (40% female, mean age 72 ± 12) of which 68 completed the food diary. The mean thirst score was 28 ± 25, and 25% experienced severe thirst. The majority of patients (94%) were prescribed a fluid restriction, 37% had a restriction between 1500 and 2000 mL, and 32% a restriction of 1500 mL. Severe thirst in the total group with 100 patients was associated with a higher dose of loop diuretics [odds ratio (OR) 3.25; 95% confidence interval (CI) 1.01-10.45; P = 0.048] and a higher urine output over 24 h (OR 1.002; 95% CI 1.00-1.003; P = 0.010). In the group of patients who completed the food diary (N = 68), severe thirst was associated with a higher sodium intake (OR 1.002; 95% CI 1.001-1.003; P = 0.003), a higher dose of loop diuretics (OR 22.69; 95% CI 2.78-185.04; P = 0.004), and more fatigue (OR 11.2; 95% CI 1.54-82.12; P = 0.017).
A quarter of all stable HF patients experienced severe thirst. A higher dose of loop diuretics was associated with more thirst; therefore, it might be important to review the dose of loop diuretics critically and try to decrease it in order to relieve severe thirst. Because all patients were prescribed a fluid restriction, a reconsideration of this restriction is also suggested.
心力衰竭（HF）患者可能会经历的一种令人不适的症状是口渴。关于口渴与液体摄入和临床变量之间的关系，数据有限。因此，本研究的目的是描述稳定型 HF 患者的严重口渴，并评估与严重口渴相关的因素，包括实际液体摄入和钠摄入。
本研究采用横断面设计。纳入了荷兰两家 HF 诊所的稳定型 HF 患者，并使用 0 到 100 的视觉模拟量表评估口渴程度。他们还完成了关于口渴困扰、自我护理行为和 HF 症状的问卷。完成了 3 天的食物日记，以评估实际液体摄入和钠摄入。最后，患者收集了 24 小时的尿液。根据口渴评分和口渴困扰，将患者分为严重口渴和轻度口渴两组。采用 t 检验、Mann-Whitney 检验和 χ 检验评估两组间的差异。采用多变量逻辑回归分析评估与严重口渴相关的因素。共纳入 100 例患者（40%为女性，平均年龄 72±12 岁），其中 68 例完成了食物日记。口渴评分平均为 28±25，25%的患者出现严重口渴。大多数患者（94%）被开具了液体限制处方，37%的患者限制在 1500 至 2000ml，32%的患者限制在 1500ml。在 100 例患者的总体组中，严重口渴与更高剂量的袢利尿剂[比值比（OR）3.25；95%置信区间（CI）1.01-10.45；P=0.048]和 24 小时内更高的尿量（OR 1.002；95%CI 1.00-1.003；P=0.010）相关。在完成食物日记的患者组（n=68）中，严重口渴与更高的钠摄入量（OR 1.002；95%CI 1.001-1.003；P=0.003）、更高剂量的袢利尿剂（OR 22.69；95%CI 2.78-185.04；P=0.004）和更多疲劳（OR 11.2；95%CI 1.54-82.12；P=0.017）相关。
四分之一的稳定型 HF 患者出现严重口渴。更高剂量的袢利尿剂与更多口渴相关；因此，仔细审查袢利尿剂的剂量并尝试降低剂量以缓解严重口渴可能很重要。由于所有患者都被开具了液体限制处方，因此也建议重新考虑这种限制。
