Fluid Restriction in Patients With Heart Failure
Fluid Restriction in Patients With Heart Failure
There is a concept increasingly consolidated by clinical evidence that at each
 hospitalization due to HF decompensation there is a substantial loss of quality of life,
 which is associated with an initial period of great clinical vulnerability, with high rates
 of rehospitalization and an increased risk of death. The non-pharmacological measures that
 are widely practiced and recommended for HF patients, such as fluid restriction, specially at
 the first 30 days after hospital discharge, still lack clearer evidence of their therapeutic
 efficacy.
The need for hospitalization is an important marker of poor prognosis in patients with heart
 failure. It is estimated that 25% of patients presenting with acute heart failure are
 readmitted within 30 days. The maintenance of signs and symptoms of congestion at hospital
 discharge are common causes of hospital readmission. Thus, the reduction of these signs is a
 goal to be reached during hospitalization so that the chances of readmission are reduced.
 However, there is evidence that approximately ¼ of the patients are released despite
 persisting signs of congestive symptoms. It seems plausible to speculate that patients with
 HF at higher risk of rehospitalization would be those with the greatest chance of benefiting
 from therapeutic strategies that seek to reduce the congestive state, such as fluid
 restriction. In this scenario of initial vulnerability after hospitalization for acutely
 decompensated HF, recent studies have demonstrated a correlation in the number of B lines in
 the pulmonary ultrasound of patients at the time of hospital discharge and the prediction of
 frequent clinical outcomes. It was observed that the presence of pattern B, defined as the
 presence of more than 3 B lines in at least 2 pulmonary fields bilaterally, was associated
 with a worse prognosis (mortality from all causes and hospitalization due to decompensation).
 The present study, therefore, will evaluate the effect of outpatient fluid restriction on
 levels of NT-proBNP in patients who remain with signs of congestion based on pulmonary
 ultrasound at the bedside during hospital discharge.
Inclusion Criteria:

 -  Hospital admission for primary diagnosis of acutely decompensated heart failure,
 regardless of etiology, according to the criteria of the American College of
 Cardiology;

 -  Diagnosis on echocardiography of heart failure with reduced ejection fraction (<40%);

 -  Presence of pulmonary congestion defined as at least 2 pulmonary fields with more than
 3 B lines in each field on pulmonary ultrasound at the time of hospital discharge.

 Exclusion Criteria:

 -  Pulmonary fibrosis or other severe disease that changes the image acquisition
 (significant pleural effusion, severe pulmonary emphysema, previous pneumectomy or
 lobectomy, primary or metastatic lung cancer, breast implants);

 -  Pregnancy;

 -  Dialysis renal failure patient;

 -  Factors that could hinder follow-up (not returning to the outpatient clinic of
 Hospital de Clínicas);

 -  Disability or refusing to understand and adhere to the protocol;

 -  Refusal to sign consent form.