Thirst Continues to Be Troublesome Among Patients With Heart Failure

Results from a recent study from Spain examining thirst among patients with heart failure show that 99% of the patients had prescribed fluid restriction between 1.5 and 2 L/day and close to half were frequently thirsty, which is considered a troublesome symptom in these patients, reports Heart & Lung.

Thirst among patients with heart failure is a known common condition and predictor of thirst trajectory following hospital discharge, but it has not been studied extensively in warmer Mediterranean climates, such as Spain, which can “have different food and cultural habits that might influence the sensation of thirst,” the authors noted. Similar studies have typically focused on countries in the temperate zone.

This cross-sectional study involved 302 patients with diagnosed heart failure recruited from a university hospital in Spain between September and November 2018. Their median (SD) age was 67 (12) years, 74% were male, and the mean left-ventricular ejection fraction (LVEF) was 43% (14%), with 45% having an LVEF <40%. Seventy-eight percent had New York Heart Association (NYHA) class II disease. The primary objectives were to describe, compare, and identify factors linked with frequent thirst in patients with chronic heart failure.

Thirst was measured using a Visual Analogue Scale (VAS), from no thirst (0 mm) to worst possible thirst (100 mm), and the patients were divided into 2 groups: never/sometimes thirsty (several times a week/month) and frequently thirsty (almost every day or every day). There was a greater thirst intensity (VAS, 50 [20-67] mm vs 7 [0-20]; P < .001) among the close to half of patients (47%) who were frequently thirsty and who fell into the 25th and 75th percentiles, respectively, of thirst.

The overall mean (SD) thirst value was 1.8 (95% CI, 1.7-2.0) compared with 2.5 (95% CI, 2.2-2.8) in the frequent-thirst group and 1.2 (95% CI, 1.1-1.3; P < .001) in the never/sometimes thirsty group. Thirst value was determined on a scale of 1 to 5 by answering 2 questions: how often have you been thirsty during the last month and when you are thirsty, how long does your thirst last.

Following regression analysis, an independent association was shown to exist between thirst and the following variables:

• Less treatment with angiotensin receptor blockers (odds ratio [OR], 2.72; 95% CI, 1.33-5.58)
• Diuretics > 40 mg/day (OR, 1.92; 95% CI, 1.02-3.64)
• Depression (OR, 2.99; 95% CI, 1.17-7.62)
• Male gender (OR, 1.98; 95% CI, 1.08-3.64)
• Worse NYHA functional class (OR, 1.92; 95% CI, 1.05-3.52)

These results point to 4 possibilities, the authors indicate, for further investigation:

1. Link between thirst distress and dimensions of thirst (eg, intensity, frequency, duration, quality)
2. Could other variables help to explain differences in thirst sensation
3. Effective treatment/management of thirst
4. Relationship of thirst to heart failure outcomes

“About half of patients with HF and fluid restriction experienced frequent thirst in a Mediterranean area of Spain. The results may help to identify patients at higher risk of frequent thirst, such as patients receiving diuretics >40 mg/day, not receiving [an angiotensin II receptor blocker], having worse NYHA class and depression,” the authors concluded. “Also, the results might possibly suggest therapeutic changes in order to diminish this troublesome symptom.”

Reference

Eng SH, Jaarsma T, Lupón J, et al. Thirst and factors associated with frequent thirst in patients with heart failure in Spain. Heart Lung. Published online August 11, 2020. doi:10.1016/j.hrtlng.2020.08.002