Factors affecting thirst in heart failure, thirst dimensions, and the consequences of thirst. There is also a need to perform rigorous randomized trials, where HF patients are given various volumes of fluids in order to intervene with thirst. Higher Diuretic Requirements in Acute Heart Failure With Admission Hyponatraemia Versus Normonatraemia. Authors N.W. Further research to improve the understanding of the severity of thirst and its relationship to possible factors associated with thirst is required in order to develop future interventions to either prevent or alleviate troublesome thirst in patients with heart failure. Thirst response to acute hypovolaemia in healthy women and women prone to vasovagal syncope. In previous studies, the VAS has been used to estimate thirst intensity in HF patients16 or in patients with renal failure undergoing dialysis treatment,25 as well as in healthy individuals.26,27 Although the VAS has been validated to measure pain, it has not been validated specifically for thirst.28,29 Valuable information can still be gained by using the VAS score, for instance that thirst intensity was three times higher in worsening HF compared with age‐matched controls.21 It can be noted that elderly patients often have an impaired thirst signal, which is probably due to reduced cerebral blood flow and attenuated sensitivity of receptors responding to changes in central blood volume.30,31, In stable HF, thirst intensity is lower16,17,20 than in uncompensated HF,21 but still much higher compared with healthy controls (Figure 3). The research questions were as follows. Camera on Vessel: A Camera-Based System to Measure Change in Water Volume in a Drinking Glass. International Journal of Nursing Practice. Although patients with heart failure (HF) may suffer from severe thirst, this has received little attention in scientific studies. Systolic congestive heart failure makes it difficult for the heart to pump blood through the body, meaning that other organs get less blood than they need. The only drug reported to increase thirst in HF was tolvaptan, a selective vasopressin V2 receptor blocker antagonist.18 Moreover, patients who were interviewed associated increased thirst with the loss of body water caused by diuretics.22 They also stated fluid restriction to be associated with troublesome thirst.22–24 In an intervention study, patients with stable HF with a fluid restriction graded thirst intensity higher (median 51, interquartile range 16–69) than those with liberal fluid intake (23, 6–53; P < 0.001).16, Among the psychological factors, one study with anxious patients with worsening HF (n = 15) (EQ‐5D) graded thirst higher (median = 85 mm) compared with eight patients without anxiety (median = 57; P < 0.04).21, The HF condition can also affect thirst. Racial Differences in Diuretic Efficiency, Plasma Renin, and Rehospitalization in Subjects With Acute Heart Failure. Current Opinion in Supportive and Palliative Care. In addition, therapy and lifestyle may influence the various paths of thirst mechanisms. Therefore, a systematic literature review was conducted to identify and analyse published data on thirst in patients with HF. Your message has been successfully sent to your colleague. Thirst intensity, as expressed by a visual analogue scale (VAS, 0–100 mm), on heart failure, healthy volunteers, and on acutely ill elderly patients without heart failure. Effects of limiting fluid intake on clinical and laboratory outcomes in patients with heart failureAuswirkungen einer begrenzten Flüssigkeitsaufnahme auf die klinischen und Laborwertergebnisse bei Patienten mit Herzversagen. In healthy persons, thirst can be defined as a sensation and desire that causes a powerful behavioural strive to drink.6 Thirst can be experienced and expressed by patients in various ways.7,8 This feeling may be so intense that the urge to drink becomes irresistible and causes distress.7. In another study, serum sodium was 140 mmol/L on admission to hospital due to worsening of HF.21 These data represent normal concentrations of sodium and cannot be the reason for increased thirst. Although it does not make you feel uncomfortable, it can impair your renal function and make your kidney disease worse. If you're not a subscriber, you can: You can read the full text of this article if you: Institutional members Fluid restriction in patients with heart failure: how should we think?. Worsening HF (80 y), NYHA III–IV, EF 32%. Some heart-related conditions an individual can develop include heart disease, heart failure, an aneurysm, peripheral artery disease, heart arrhythmia, sudden cardiac arrest, heart attack, stroke, valvular heart disease, heart infection, cardiomyopathy, and congenital heart defects. The symptoms of heart failure can make it difficult for some people to live their lives normally. The symptoms produced by right-sided heart failure c… HF patients with the highest NYHA classifications had higher thirst intensity (Figure 4).21 Another study using the VAS included patients with stable HF divided into an intervention group with fluid and salt restriction and a control group with no restrictions.19 It was not explicit how the question about thirst intensity was presented to the patients. Thirst is a common and burdensome symptom of heart failure, which impacts adversely on quality of life. The “thirsty dropsy”: Early descriptions in medical and non-medical authors of thirst as symptom of chronic heart failure. If you're excessively thirsty even when drinking lots of water, your body may be pointing to one of these underlying health issues. The consequences of thirst in HF were related to compliance, preoccupation with thirst, and a negative impact on quality of life. A decrease in plasma volume increases levels of angiotensin II. [email protected]. Based on the JBI levels of evidence,15 the studies were ranked according to the research findings most likely to provide valid information on the effectiveness of a treatment/care option. The mean age ranged from 44 to about mean 80 years, and the mean ejection fraction ranged from 23% to 45%. More research is needed to study the thirst mechanisms, the effects of thirst, and effective interventions to relieve troublesome thirst in HF patients. Four studies comprising 181 patients provided visual analogue scale (VAS) scores. The aim was to highlight current knowledge of thirst in HF. Some idea about factors that promote thirst can be obtained from studies on patients with renal failure. These dimensions were measured using various tools or captured during interviews. your express consent. A systematic literature review was conducted to identify and analyse data on thirst in HF. Surprisingly, there are no studies examining the effects of specific interventions (e.g. Allida, Sabine M.a; Hayward, Christopher S.b,c; Newton, Phillip J.d, aImproving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, cCardiology Department, St Vincent's Hospital, dNursing Research Centre, Western Sydney Local Health District and Western Sydney University, Sydney, Australia, Correspondence to Phillip J. Newton, Nursing Research Centre, Western Sydney Local Health District and Western Sydney University, Locked Bag 1797 Penrith, NSW 2751, Australia. (iii) How does thirst affect patients with HF? Of the quantitative studies, two were descriptive20,21 and four articles presented randomized controlled trials,16–19 of which two articles16,17 were from the same study. In one study of stable HF patients, thirst distress was examined and measured with the Thirst Distress Scale (TDS).20 The questionnaire consisted of six items with scores ranging from 1 (strongly disagree) to 5 (strongly agree). Number of times cited according to CrossRef: Thirst in Patients With Heart Failure in Sweden, the Netherlands, and Japan. 5 - If you suspect that you have been infected, you should practice self-quarantine and contact your primary care physician, heart failure nurse or heart failure physician for further recommendations regarding the necessity of testing for the COVID-19 virus. Heart failure is a serious condition, but it does not actually mean that your heart has failed. These data indicate that thirst is increased in HF and becomes more intense during periods of worsened HF. Extreme fatigue. Heart infections. fluid restriction, heart failure, interventions, thirst. For information on cookies and how you can disable them visit our Privacy and Cookie Policy. © The Author 2012. People with Heart Failure often have other conditions, such as diabetes, high blood pressure, COPD, or obesity. We found no studies that included measurements of serum osmolality or angiotensin II, which are markers known to increase thirst. This structured form was developed into a synopsis and presented in tabular form (Table 1). The patients with the highest thirst intensity were reported to be anxious.21 Anxiety is prevalent in HF and has been shown to have an impact on associated symptoms.32–34 The link between severe thirst and anxiety might be due to activation of the sympathetic nervous system as well as worsening HF. Heart Failure Is Often Misunderstood. after 12 weeks (NS), Identify relationships between fluid intake, thirst, and QoL in persons with HF, Distress: 46% reported moderate to strong discomfort from thirst, Explore reasons and motivations for compliance with HF regimen and how patients manage these recommendations, Quality: thinking about thirst the whole day, Compare the intensity of thirst in elderly patients with (A) and without (B) HF. Although patients with heart failure (HF) may suffer from severe thirst, this has received little attention in scientific studies. ice‐cubes). One paper presented thirst as a primary outcome21 and five papers as a secondary outcome.16–20 In three articles, thirst was presented as patient statements during interviews dealing with maintenance of daily life in HF, motivations for compliance, and the meaning of living with severe chronic HF.22–24 One study examined patients with worsening HF.21 One qualitative study included only patients with stable but severe HF,22 while seven articles consisted of patients in a stable phase of HF.16–20,23,24. For example, diuretics may give rise to thirst by inducing dehydration. A survey of views and opinions of health professionals managing thirst in chronic heart failure. Your account has been temporarily locked due to incorrect sign in attempts and will be automatically unlocked in Developed in collaboration with the Heart Failure Association (HFA) of the ESC, Impact of symptom prevalence and symptom burden on quality of life in patients with chronic heart failure, Predictors for health‐related quality of life in persons 65 years or older with chronic heart failure, Symptom distress and quality of life in patients with advanced congestive heart failure, Symptoms experienced in the last six months of life in patients with end‐stage heart failure, Thirst, drinking behaviour and involuntary dehydration, Collaborative development of middle‐range nursing theories: toward a theory of unpleasant symptoms, Advancing the science of symptom management, Thirst and hydration: physiology and consequences of dysfunction, Guyton and Hall Textbook of Medical Physiology, A middle‐range theory of self‐care of chronic illness, Role of self‐care in the patient with heart failure, Compliance in heart failure patients: the importance of knowledge and beliefs, Fluid overload and other mechanisms beyond fluid accumulation, Joanna Briggs Institute Reviewerś Manual: 2011 Edition, Liberal versus restricted fluid prescription in stabilised patients with chronic heart failure: result of randomised cross‐over study of the effects on health‐related quality of life, physical capacity, thirst and morbidity, Description of self‐reported fluid intake and its effects on body weight, symptoms, quality of life and physical capacity in patients with stable chronic heart failure, Effects of oral tolvaptan in patients hospitalised for worsening heart failure: the EVEREST outcome trial, A pilot study of salt and water restriction in patients with chronic heart failure, Thirst and QOL in persons with heart failure, Thirst in the elderly with and without heart failure, Living with severe chronic heart failure in palliative advanced home care, Keeping the maintenance of daily life in spite of chronic heart failure. Thirst can negatively affect compliance with treatment in HF and weight gain, lead to preoccupation with thirst, and therefore have an impact on the HF patient's QoL. 10 Signs of Heart Failure You Should Never Ignore, According to Doctors. Articles in Google Scholar by Sabine M. Allida, Other articles in this journal by Sabine M. Allida. Of 174 screened citations, nine articles were included, in which a total of 4375 HF patients had been studied. These search terms had to be identified anywhere in the text in the articles. The other study examined whether patients with stable HF were able to reduce their fluid and sodium intake without negative effects on thirst, appetite, and quality of life.19 The primary endpoint was to reduce significantly the intake of salt to 2–3 g/day (equal to 5–7.5 g salt) and the water intake to 1.5 L/day. The patients were asked to grade their sense of thirst on a 100 mm long horizontal line, which was marked ‘no thirst’ on the left side and ‘constant thirst’ on the right side.16,17,19,21 In one study, median thirst intensity according to VAS was 75 mm (interquartile range 56–90) in worsening HF on admission to hospital.21 Matched control patients without HF scored 25 mm (11–40; P < 0.0001) (Figure 3). Congestive heart failure happens when the heart is not able to pump enough blood to meet the demands of the body. Gastroenteritis is inflammation of the stomach and intestine that causes diarrhea and vomiting. Journal of Cardiovascular Pharmacology and Therapeutics. The number of included women was higher in the older age group (mean 80 years).21 Investigations or interviews took place in hospital, at a clinic, or in patients' homes. The key inclusion criterion was that HF had been diagnosed according to the current guidelines at the time of the study. Although there were no intervention studies on thirst, two studies had thirst as a secondary outcome measure. Median thirst intensity ranged from 23 to 75 mm (VAS 0–100 mm). The first one primarily compared the effects of restrictive vs. liberal fluid on QoL and secondarily on thirst, physical capacity, and hospital admissions in stable HF.16,17 Liberal fluid intake (mean 23 mL/kg/day) had a favourable effect on thirst in comparison with fluid restriction (17 mL/kg/day).16 Sixteen weeks after starting the intervention, the thirst intensity in the liberal fluid group was lower (median 23, interquartile range 6–53) compared with the fluid restriction group (51, 16–69; P < 0.001).16 The study also showed that liberal fluid intake was significantly less difficult to adhere to (median 6, interquartile range 1–24, graded by VAS) in comparison with fluid restriction (23, 5–56; P < 0.001).17 The intervention showed no effect on QoL. Certain conditions, such as narrowed arteries in your heart (coronary artery disease) or high blood pressure, gradually leave your heart too weak or stiff to fill and pump efficiently.Not all conditions that lead to heart failure can be reversed, but treatments can improve the signs and symptoms of heart failure and help you live longer. They affect different parts of the heart … The qualitative studies were not ranked as there is no widely accepted hierarchy of evidence for qualitative studies.15 All studies were assessed to be of good or adequate quality based on the methodological validity according to JBI.15 One study was presented as a research abstract20 and eight as full‐length articles. People with right-sided heart failure develop symptoms because the right side of their hearts (the side that receives blood returning to the heart from the rest of the body, and pumps it out to the lungs) is unable to keep up with the work it is required to do. By using a prospective study design, the effects of thirst could be studied based the number of deteriorations and hospital admissions, morbidity, mortality, and QoL of HF patients. All rights reserved. For more information, please refer to our Privacy Policy. Clinical Journal of the American Society of Nephrology. Anxiety. Despite the burden of thirst in heart failure patients, strategies to relieve thirst remains insufficiently addressed in literature. It means that your heart is not pumping blood around your body very efficiently. Your lungs aren't the only part of your body that can be affected by edema; for many heart disease patients, edema of the lower extremities is a sign that their ticker needs a tune-up. Gastroenteritis. A qualitative study, Qualitative examination of compliance in heart failure patients in the Netherlands, Quenching the thirst in dialysis patients, Reduced osmotic thirst in healthy elderly men, Regulation of fluid intake in dehydrated humans: role of oropharyngeal stimulation, Pain measurement tolls for clinical practice and research, Sensation and distress of pain scales: reliability, validity and sensitivity, Effect of aging on regional cerebral blood flow responses associated with osmotic thirst and its satiation by water drinking: a PET study, Mechanism of attenuated thirst in aging: role of central volume receptors, Comparison of prevalence of symptoms of depression, anxiety, and hostility in elderly patients with heart failure, myocardial infarction and a coronary artery bypass graft, Psychological and social factors that correlate with dyspnea in heart failure, Self‐care management of heart failure: practical recommendations from the patient care committee of the Heart Failure Association of the European Society of Cardiology, Edema of cardiac origin. You may search for similar articles that contain these same keywords or you may It occurs in about 1% of people aged 50-59, but becomes more common in the age group 80-89 where its occurrence rate is over 50%, so it certainly is not uncommon. Both men and women were included in all studies. Avoiding fluid overload if you have heart failure . The role of the thirst sensation is to ensure behaviour to drink.9 Regulation of thirst is primarily governed by the body fluid osmolality and changes in plasma volume (Figure 1). modify the keyword list to augment your search. Reproduced from Simon Thornton, Thirst and hydration: physiology and consequences of dysfunction. 30 mins. Being thirsty from time to time is normal. . First, there must be studies that explore the prevalence, severity, and origin of excessive thirst in HF. Chronic heart failure tends to affect elderly people. Hyponatremia in Acute Decompensated Heart Failure. A high serum sodium concentration raises the serum osmolality which, in turn, stimulates the osmoreceptors and gives rise to thirst.10 In patients with stable HF, the serum sodium concentration has averaged 140 and 138 mmol/L regardless of ingested fluid volume or intake of salt.16,17,19 In these studies, the relationship between thirst and serum sodium was not reported. Of course, the more medications you take, the easier it is to make a mistake (such as missing a dose). access full text with Ovid®. The full text of this article hosted at iucr.org is unavailable due to technical difficulties. It may take a bit longer, but breaking jobs down into smaller tasks can help - and it means that you’re still able to do the things you want to do. Only chewing of gum has been tested with regards to alleviating thirst in renal failure patients, but with negative or ambiguous results.48,49. : a Camera-Based System to measure Change in water and sodium homeostasis in the articles serious,... 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