1 | INTRODUCTION
Heart failure (HF) is a chronic and complicated syndrome1,2. Although HF treatment has developed, the
long-term mortality improves poorly 3-5. More than 1
million of HF patients are hospitalized each year, which almost occupy
the top reason for elderly subjects admitted to hospital and account for
more than $30 billion of health care expenditure in USA6,7. HF decrease their quality of life (QOL), and
effective treatment and care could remarkably alleviate their signs and
discomforts 8.
Although fostering self-management
skills in HF patients seems to be useless to reduce their mortalities,
it could improve their QOL and decrease readmission rates9. Surprisingly, the awareness rate of HF is much
lower than that of expected in these patients, even those who have
recurrent HF symptoms and follow the medical instructions for many years10,11. Meanwhile, most HF patients usually feel
unprepared to manage their life styles at home 8.
Fluid management plays a pivotal role in the self-care of HF patients,
which could avoid the recurrent dyspnea symptoms 1,2.
However, an effective fluid management is a challenging task for HF
patients owing to the dynamic fluid status. Evaluation of fluid
situation in vivo include monitoring body weight, counting fluid
intake and output as well as physical examination (e.g. jugular venous
distention, hepatojugular reflux, lung rales and pedal edema). Physical
examination usually need the assistance of health care professionals1,2,12. While either in hospital or at home,
monitoring body weight and recording fluid changes of intake and output
remain two basic issues, especially after HF patients return to their
daily life. In fact, it is controversial to regard body weight as a
major indicator for fluid evaluation. Because body weight is often
affected by many factors, including clothes, diet, testing time, and
ambient temperature 13. Additionally, monitoring body
weight sometimes is not easy to be performed, especially in those
patients who are bedridden for years. Although many clinic guidelines
for HF recommend that these patients should record their body weight
every day, almost few acute HF accidences are forecasted through
monitoring body weight due to the lower sensitivity of weight gain (9%)14.
In addition, there are great differences in the diet compositions and
habits between Western and Eastern subjects, causing an inconsistent
understanding for water contained in foods. In Western countries,
besides common solid and liquid foods, people often consume much
semi-solid foods (e.g. purees and gelatin) which contain much water, and
fluid in these foods is often calculated and counted13. In China, water in solid foods is also calculated
and converted to fluid intake based on the moisture scales of foods
following the professional fluid intake recoding schemes15. Additionally, it is awkward that the feces should
always be considered. And the differences of ingredients and cooking
methods, the irregularity of cognition in HF patients and their family
members, and the tedious mode of professional recording scheme could all
cause the poor compliance of monitoring fluid intake and output16. Therefore, whether the professional recording
scheme could be simplified more easily for the self-management of HF
patients
at
home, should be reconsidered.
In this study, a simplified recording scheme of fluid intake and output
for HF patients was developed, which was safe, efficient and
non-inferior to the professional mode in
clinical
stability, electrolyte imbalances and cardiac functions. This modified
fluid recording mode, as an effective supplement to body weight for
fluid self-management, might improve their QOL and reduce their
recurrent hospitalization times for HF patients.