ACC 25 - FRESH-UP shows liberal fluid intake did not result in a significant difference in health status compared to fluid restriction of 1500ml per day, but did result in a lower perceived thirst distress.

Dr Harriette Van Spall (McMaster University, CA) sits down with Dr Roland Van Kimmenade (Radboud University Medical Center, Nijmegen, NL) to discuss the findings from the multi-center, randomized FRESH-UP Trial (NCT04551729) investigating whether fluid restriction impacts quality of life in chronic heart failure patients. The study enrolled 504 participants across eight centers in the Netherlands, who were randomized 1:1 to either follow a restricted fluid intake of 1500cc per day, or maintain a liberal fluid intake for three months.

The primary outcome measure was quality of life, measured using the Kansas City Cardiomyopathy Questionnaire (KCCQ) at three months. Secondary outcomes included thirst distress, and KCCQ subscores. KCCQ-OSS at three months was 74.0 in the liberal fluid intake group, compared to 72.2 in the fluid restriction group, with a mean difference of 2.17 (95% CI -0.06-4.39; P=0.06).

Findings of the study suggest that liberal fluid intake does not harmfully impact heart failure patients, questioning the need for fluid restriction amongst patients with stable, symptomatic chronic heart failure.

Recorded Remotely from Hamilton and Maastricht, 2025. 
Editors: Yazmin Sadik, Jordan Rance
Videographers: Dan Brent, David Ben-Harosh

Support: This is an independent interview produced by Radcliffe Cardiology.