Fluid Restriction vs Liberal Fluid Intake in Heart Failure: A Systematic Review and Meta-analysis

Background There are limited and heterogeneous data on fluid restriction in the management of chronic heart failure (HF). This study sought to conduct a meta-analysis of existing randomized controlled trials (RCT). Methods We systematically searched PubMed, Embase, and Cochrane Central for RCTs comparing restrictive and liberal fluid intake in HF. Primary outcomes included all-cause hospitalization and all-cause mortality. Secondary outcomes included quality of life, weight changes, clinical congestion score, and biochemical markers. Results Nine RCTs (n=1,335) were included, with 666 patients assigned to fluid restriction and 669 to liberal intake, comprising 500 patients with NYHA class II and 251 patients with NYHA class III. Baseline characteristics were comparable between cohorts. All-cause hospitalization (RR 0.75; 95% CI: 0.51, 1.11; p=0.154) and all-cause mortality (RR 0.62; 95% CI: 0.36, 1.08; p=0.093), quality of life (SMD: 0.12; 95% CI: -0.28, to 0.52), body weight (MD: –0.10 kg; 95% CI: –0.36, 0.17), and clinical congestion score (MD: -0.01; 95% CI: -0.71, 0.68) were not statistically significantly different between the groups. The renal and cardiac biomarkers did not differ between the two cohorts. Conclusion This meta-analysis reports no significant differences in major clinical outcomes between liberal fluid intake versus fluid restriction in patients with HF.