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Fluid Restriction in HF — EECC MCQ

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EasyHeart FailureFluid Restriction in HFEECC

A 70-year-old man with HFrEF asks about fluid restriction. His daily weight is stable and he is well compensated on GDMT with furosemide 40 mg daily. His sodium is 138 mmol/L. Should fluid restriction be recommended?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — Routine fluid restriction is not recommended in euvolaemic HF patients with normal serum sodium; it may be considered in hypervolaemic patients with hyponatraemia (<130 mmol/L)

The 2023 ESC HF Guidelines do not recommend routine fluid restriction for all HF patients. Fluid restriction (typically 1.5-2 L/day) may be considered in: (1) hypervolaemic patients with dilutional hyponatraemia (Na⁺ <130 mmol/L); (2) advanced HF with refractory congestion; (3) during acute decompensation. The AVOID-HF and other studies failed to show benefit of routine fluid restriction in stable compensated HF. Overly restrictive fluid intake can worsen quality of life, reduce renal perfusion, and may paradoxically activate neurohormonal systems. Self-monitoring of daily weight (reporting gains >2 kg in 3 days) is more useful than strict volume restriction.

Reference: ESC (2023): Focused Update on Heart Failure