Höög Linn, Strömberg Anna, Waldréus Nana, Nymark Carolin
Department of Cardiology, Heart and Vascular Center, Karolinska University Hospital, Stockholm, Sweden.
Department of Neurobiology, Care Sciences and Society, Karolinska Institute Sweden, Stockholm, Sweden.
ESC Heart Fail. 2025 Aug;12(4):2769-2779. doi: 10.1002/ehf2.15273. Epub 2025 Mar 18.
Due to insufficient evidence and a lack of cohesive guidelines, the management and use of fluid restriction in patients with heart failure (HF) may vary among healthcare professionals. However, the extent of this variation is unknown. The aim of this study was to describe physicians' and registered nurses' (RN) clinical practice regarding fluid intake and fluid restriction in adult patients with HF.
Physicians and RNs treating patients with HF at 75 hospitals across all healthcare regions in Sweden were invited to answer a web-based survey regarding management on fluid intake and fluid restriction. Data were analysed with descriptive statistics and chi-square test. A total of 646 physicians and RNs across 45 hospitals in Sweden completed the survey. Significant differences in recommendations and management were found in relation to professional role, care setting and work experience. Overall, 93.8% recommend fluid restriction for all or some patients with HF. RNs recommend fluid restriction for all patients with HF to a significantly higher extent compared with physicians (34.5% vs. 14.9%; P < 0.001). Additionally, 49.2% believe that fluid restriction is an effective treatment strategy to prevent congestion, and 29.3% recommend fluid restriction routinely. One-third lacked knowledge of existing local guidelines regarding fluid restriction.
This study shows that there are differences in clinical practice regarding healthcare professionals' recommendations on fluid intake and fluid restriction. These differences may result in patients with HF receiving varied and inconsistent care. Recommendations were primarily based on each healthcare professional's individual opinion rather than on evidence and guidelines.
由于证据不足且缺乏统一的指南，心力衰竭（HF）患者液体限制的管理和应用在医疗专业人员中可能存在差异。然而，这种差异的程度尚不清楚。本研究的目的是描述医生和注册护士（RN）在成年HF患者液体摄入和液体限制方面的临床实践。
邀请瑞典所有医疗区域75家医院治疗HF患者的医生和RN回答关于液体摄入和液体限制管理的网络调查问卷。数据采用描述性统计和卡方检验进行分析。瑞典45家医院的646名医生和RN完成了调查。在推荐和管理方面，发现与专业角色、护理环境和工作经验有关的显著差异。总体而言，93.8%的人建议对所有或部分HF患者进行液体限制。与医生相比，RN建议对所有HF患者进行液体限制的比例显著更高（34.5%对14.9%；P<0.001）。此外，49.2%的人认为液体限制是预防充血的有效治疗策略，29.3%的人常规推荐液体限制。三分之一的人对现有的关于液体限制的当地指南缺乏了解。
本研究表明，医疗专业人员在液体摄入和液体限制建议方面的临床实践存在差异。这些差异可能导致HF患者接受不同且不一致的护理。建议主要基于每个医疗专业人员的个人意见，而非证据和指南。
