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.