The Effect of a Change in Fluid Intake Advice on Outcomes in Chronic Heart Failure: A prespecified subanalysis of the FRESH-UP Study.

Authors

Job J Herrmann, Hans-Peter Brunner La Rocca, Lisette E H J M Baltussen, Fabienne Beckers Wesche, Sebastiaan C A M Bekkers, Louise Bellersen, J W Martijn Van Eck, H Carlijne Hassing, Tiny Jaarsma, Gerard C M Linssen, Ron Pisters, Sandra Sanders Van Wijk, Marjolein H I Verdijk, Laura Rodwell, Roland R J van Kimmenade, D H Frank Gommans

Published in

ESC heart failure. Jul 29, 2026. Epub Jul 29, 2026.

Abstract

The FRESH-UP study (NCT04551729) randomized patients with chronic heart failure (HF) to liberal fluid intake (LFI) versus fluid restriction (FR). Pre-trial fluid management may have impacted trial outcomes.
The open-label FRESH-UP study randomized 504 patients with chronic HF to an advice of LFI or FR of 1500 ml/day. Primary outcome was Kansas City Cardiomyopathy Questionnaire Overall Summary Score (KCCQ-OSS) after three months adjusted for baseline. Key secondary outcome was thirst distress. Patient-reported fluid intake was assessed at week six. Safety outcomes included death and hospitalizations. For this subanalysis participants were stratified according to pre-trial fluid management (FR or LFI).
Prior to randomization, 269(53.4%) patients adhered to FR vs 235(46.6%) to LFI. After three months follow-up, KCCQ-OSS was significantly different between groups (P = 0.035): in patients changing from pre-trial FR to LFI, KCCQ-OSS was 74.7 (95%CI 71.2-78.3) compared to 70.2 (95%CI 66.3-74.2) in those with the reversed scenario. In the latter group, thirst distress increased the most. Patient-reported fluid intake was significantly higher in patients randomized to LFI when compared to FR (P = 0.019), regardless of pre-trial FR or LFI (1771ml and 1757ml, versus1486 ml and 1464 ml, respectively. Safety outcomes did not differ.
These analyses add understanding to the effects of fluid intake management in chronic HF and expose a signal of potential harm of FR in patients with pre-trial LFI and a potential benefit of LFI in patients with pre-trial FR. These results corroborate with the primary results and support that there is no need to routinely initiate or continue FR in stable patients with chronic HF.

PMID:
42522568
Bibliographic data and abstract were imported from PubMed on 29 Jul 2026.

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