Thirst trajectory and factors associated with persistent thirst in patients with heart failure

The Prevalence and Risk Factors for Postoperative Thirst: A Systematic Review and Meta-analysis

PURPOSE

Thirst is a symptom of dehydration and one of the main complications affecting postoperative outcomes and comfort. Persistent water scarcity can have a detrimental effect on the cognitive function and psychology of patients. However, the current evidence about the prevalence and risk factors for postoperative thirst is not fully understood. Therefore, this study aims to investigate the prevalence and risk factors of postoperative thirst and provide guidance for clinical practice.

DESIGN

Systematic review and meta-analysis.

METHODS

We searched PubMed, Cochrane Library, Web of Science, Embase, Clinicaltrials.gov, China National Knowledge Infrastructure, and Wanfang Database. Eligible studies were evaluated using the Agency for Healthcare Research and Quality. The collected data were pooled and analyzed using Stata15.0.

FINDINGS

A total of 11 cross-sectional studies were included involving 20,612 patients. Eight studies reported prevalence and the pooled prevalence of postoperative thirst was 76.8% (95% confidence interval [CI]: 0.664 to 0.858). Five studies contributed to meta-syntheses of risk factors for postoperative thirst. The results indicated that sex (odds ratio [OR] = 1.44, 95% CI = 1.13 to 1.84, I2 = 80.2%, P = .006), anesthesia drug (OR = 1.48, 95% CI = 1.06 to 2.06, I2 = 94.8%, P < .001), surgical type (OR = 0.66, 95% CI = 0.49 to 0.9, I2 = 77.9%, P = .004) were statistically associated with postoperative thirst.

CONCLUSIONS

Our study shows a high prevalence of postoperative thirst. Sex, anesthesia drug, and surgical type are risk factors that influence postoperative thirst. Nurses and other health care professionals should routinely assess the postoperative thirst of patients and perform targeted interventions to alleviate their distressing symptoms and improve the quality of care.

Thirst symptoms in patients with heart failure: An integrative review

AIM

To identify the risk and protective factors affecting thirst symptoms in patients with heart failure (HF) and intervention strategies to alleviate thirst symptoms.

DESIGN

An integrative review.

METHODS

A total of 61 articles were retrieved. Screening yielded a total of 21 articles which were appraised for quality. The quality of studies was assessed using the Mixed Methods Appraisal Tool.

DATA SOURCES

Ten electronic databases were searched in October 2023, including Embase, Pubmed, CINAHL, Cochrane, Web of Science, Wiley, CNKI, VIP, CBM and WanFang. In addition, we searched grey databases and manually searched reference lists of included and relevant reviews.

RESULTS

In total, 1644 articles were retrieved, of which 21 were included. Eight studies addressed the factors. Six themes emerged as risk factors, including demographics, severity of disease, psycho-environmental, medication, fluid restriction and homeostasis. Conversely, an increase in fluid intake, a high score of sodium restriction diet attitude and using ARB were identified as protective factors. Thirteen studies focus on intervention strategies. Five unique intervention strategies were identified, including Traditional Chinese Medicine, mint-related interventions, sour-flavour interventions, improved water restriction and cluster nursing strategy.

CONCLUSION

This finding identified the factors associated with thirst symptoms in patients with HF, especially concerning the elaboration of risk factors, which suggests that healthcare professionals should focus on the risk factors for thirst in patients with HF and consciously avoid the occurrence of these risk factors. Additionally, there are considerable cultural differences in interventions, therefore, to increase adherence during symptom management, careful selection of appropriate intervention strategies based on the requirements and preferences of patients is required. While there are some therapies, there aren't enough high-quality empirical investigations. Thus, multi-centre, large-sample studies are also required in subsequent research to demonstrate the interventions' effectiveness.

IMPLICATIONS FOR THE PROFESSION

The nurse must notice the symptoms of thirst in HF to slow down the disease's progression and improve the patient's physical and emotional well-being.

REPORTING METHOD

The review complies with the PRISMA guidelines for reporting systematic reviews.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Changes over time in patient-reported outcomes in patients with heart failure

AIM

This paper describes the trajectory during 1 year of four patient-reported outcomes (PROs), namely, sleep, depressive symptoms, health-related quality of life (HrQoL), and well-being, in patients with heart failure (HF), their relationship and the patient characteristics associated with changes in these PROs.

METHODS AND RESULTS

Data analyses of PROs from 603 patients (mean age 67 years; 29% female, 60% NYHA II) enrolled in the HF-Wii study. On short term, between baseline and 3 months, 16% of the patients experienced continuing poor sleep, 11% had sustained depressive symptoms, 13% had consistent poor HrQoL, and 13% consistent poor well-being. Across the entire 1-year period only 21% of the patients had good PRO scores at all timepoints (baseline, 3, 6, and 12 months). All others had at least one low score in any of the PROs at some timepoint during the study. Over the 12 months, 17% had consistently poor sleep, 17% had sustained symptoms of depression, 15% consistently rated a poor HrQoL, and 13% poor well-being. Different patient characteristics per PRO were associated with a poor outcomes across the 12 months. Age, education, New York Heart Association, and length of disease were related to two PRO domains and submaximal exercise capacity (6 min test), co-morbidity, and poor physical activity to one.

CONCLUSION

In total, 79% of the patients with HF encountered problems related to sleep, depressive symptoms, HrQoL, and well-being at least once during a 1-year period. This underscores the need for continuous monitoring and follow-up of patients with HF and the need for dynamic adjustments in treatment and care regularly throughout the HF trajectory.

Origins of thirstiness sensation and current food solutions

The sensation of thirstiness is the desire to drink water. In certain situations, the ingestion of liquid water can be restricted. As a result, thirstiness is not relieved, resulting in an uncomfortable and distressing situation. The present review describes thirstiness and hydration, the food products and beverages that cause thirstiness, and the beverages and food products currently available to quench thirstiness in individuals with restricted access to liquid ingestion. It also discusses how to measure the effectiveness of calming thirstiness. To diminish thirstiness distress, different alternatives to liquids are proposed. Individuals with swallowing disorders are given thickened water, individuals with restricted water ingestion are given ice cubes or ice popsicles of different flavors, and sportspeople are given energy gels. However, current beverage solutions seem not to relieve thirst fully, although some stimuli like iced water, flavors (especially lemon and mint), or acids seem to work better than plain stimuli and could be added to existing products. Therefore, there is still a need to incorporate these strategies into beverage and food formulations and to test their effectiveness.

Thirst in heart failure: A scoping review

AIM

The aim of this study was to summarise the overall picture of thirst-related research in patients with heart failure.

DESIGN

We conducted a scoping review following the Arskey and O'Malley methodological framework along with the PAGER framework.

METHODS

PubMed, CINAHL, Web of Science, Embase, The Cochrane Library, Jonna Briggs Institute, ProQuest Database, Google Scholar, PsycINFO, PQDT, CNKI, Wan Fang, VIP and CBM. Additionally, grey literature including grey databases (Opengrey, OpenDoar, Openaire and BASEL Bielefeld Academic Search Engine), conferences or articles (Scopus and Microsoft Academic), graduate theses databases (eTHOS, DART Europe, Worldcat and EBSCO Open Dissertations) and government information media (UK guidance and regulations, USA government websites, EU Bookshop and UN official publications) were searched. The databases were searched from inception to 18 August 2022 for Articles written in English and Chinese. Two researchers independently screened articles based on inclusion and exclusion criteria, and a third researcher adjudicated disagreements.

RESULTS

We retrieved 825 articles, of which 26 were included. Three themes were summarised from these articles: (a) the incidence of thirst in patients with heart failure; (b) the thirst-related factors in patients with heart failure; and (c) the intervention measures of thirst in patients with heart failure.

Translation and Psychometric Evaluation of the German Version of the Thirst Distress Scale for Patients With Heart Failure

BACKGROUND

In patients with chronic heart failure, thirst can be perceived as an intensive and burdensome symptom, which may have a negative impact on patients' quality of life. To initiate thirst-relieving interventions, assessment of thirst and its related distress is essential. At the time of this study, no instrument was available to evaluate thirst distress in patients with heart failure in Germany.

OBJECTIVE

The aims of this study were to translate the "Thirst Distress Scale for patients with Heart Failure" (TDS-HF) from English into German and to test validity and reliability of the scale.

METHODS

The English version of the TDS-HF was translated into German. A linguistically and culturally sensitive forward-and-backward translation was performed. Psychometric evaluation included confirmatory factor analysis, reliability in terms of internal consistency, and concurrent validity.

RESULTS

Eighty-four hospitalized patients (mean age, 72 ± 10 years; 29% female; mean left ventricular ejection fraction, 36% ± 12%; 62% New York Heart Association functional classes III-IV, 45% on fluid restriction) from an acute care hospital were involved in the study. The item-total correlation ranged from 0.58 to 0.78. Interitem correlations varied between 0.37 and 0.79. Internal consistency was high, with a Cronbach α of 0.89. There was a high correlation between the total score of the TDS-HF and the visual analog scale to assess thirst intensity ( r = 0.72, P ≤ .001), and a low correlation with fluid restriction ( r = 0.35, P = .002).

CONCLUSIONS

The evaluation of the German TDS-HF showed satisfactory psychometric properties in this sample. The instrument is usable for further research and additional psychometric testing.

Thirst Interventions in Adult Acute Care-What Are the Recommended Management Options and How Effective Are They?: A Systematic Review

PURPOSE

The aim of this study was to review the scope and quality of evidence for thirst treatment in adult acute care.

METHODS

A systematic review was completed by 2 independent reviewers using MEDLINE, PubMed, BNI, EMBASE, EMCARE, and CINAHL databases and additional hand searching in June 2020. Interventions to relieve thirst for inpatients receiving acute care were included. Evidence was appraised against the levels of evidence for therapeutic studies, and a risk-of-bias assessment was completed for included studies. Outcomes are presented via narrative synthesis. Meta-analysis was planned.

RESULTS

Four studies (out of 844) were eligible reporting thirst outcomes from 611 critical care patients. Meta-analysis could not be completed because a priori criteria were not met. Two randomized controlled trials represented the highest level of evidence. Thirst assessment was completed via a self-reported scale in all reviewed works. Interventions included cold water sprays or swabs, menthol lip moisturizer, and use of humidification. Three works demonstrate reduced thirst scores; all interventions in these studies exploit cooling effects to the oropharynx with the aim of preabsorptive satiation of thirst. A humidified oxygen circuit showed a neutral response when compared with a nonhumidified circuit.

CONCLUSIONS

There is a limited but growing evidence base related to thirst treatment in the acute setting. Studies using a "bundle" of topical interventions incorporating cooling and menthol treatments showed positive effects in reducing symptom burden. Work to explore the scope of application for thirst treatment for patients unable to self-report, consideration of sustained effects, and a study of individual versus combined effects of bundle elements would be welcomed as the evidence base continues to develop.

Thirst distress in outpatients with heart failure in a Mediterranean zone of Spain

Aims

This study aimed to evaluate psychometric properties of the Spanish version of the Thirst Distress Scale for patients with Heart Failure (TDS‐HF) and to describe thirst distress‐associated factors in outpatients at a heart failure (HF) clinic in Spain. Thirst is common in patients with HF, but thirst distress has rarely been addressed and may significantly decrease quality of life.

Methods and results

A cross‐sectional study was performed assessing perceived thirst distress by patients with HF during the preceding 3 days, with the TDS‐HF (scores 8 to 40). Univariable and multivariable linear regression analyses were performed to identify variables independently associated with thirst distress. Three‐hundred two HF outpatients were included (age 67 ± 12 years, 74% male, HF duration 82 ± 75 months, left ventricular ejection fraction 42 ± 14%). Most patients were on treatment with fluid restriction (99%), sodium restriction (99%), and diuretics (70%). The psychometric evaluation of the Spanish version of the TDS‐HF showed satisfactory item‐total and inter‐item correlations (range from 0.77 to 0.85 and 0.60 to 0.84, respectively), and internal consistency was 0.95 (Cronbach's alpha). The majority perceived mild to moderate thirst distress, and 18% perceived it as high or severe. The mean score obtained was 16.2 ± 9.3 (median 13, Q1–Q3 8–20). Higher serum urea {beta coefficient 1.6 [95% confidence interval (CI) 0.267 to 2.92], P = 0.019} and lower potassium [beta coefficient −3.63 (85% CI −6.32 to −0.93), P = 0.009] remained significantly associated with thirst distress in the multivariable analysis, together with the dose of diuretics [beta coefficient 2.98 (95% CI 1.37 to 4.59), P < 0.001]. Treatment with angiotensin receptor blocker showed an independent protective effect [beta coefficient −3.62 (95% CI −6.89 to −0.345), P = 0.03].

Conclusions

The psychometric evaluation of the Spanish version of the TDS‐HF showed good psychometric properties. One in five patients experienced severe distress by thirst, but the majority had mild to moderate thirst distress. The dose of diuretics and angiotensin receptor blocker treatment influence thirst distress and could be clinically important targets to relieve thirst distress in patients with HF.

Changes in Appetite During the Heart Failure Trajectory and Association With Fatigue, Depressive Symptoms, and Quality of Life

BACKGROUND

Decreased appetite can contribute to malnutrition in patients with heart failure (HF). Little is known about the trajectory of appetite over time in patients with HF and the factors associated with decreased appetite after discharge from the hospital.

OBJECTIVE

The aims of this study were to investigate changes in appetite over time and explore how fatigue, depressive symptoms, and quality of life are associated with decreased appetite.

METHODS

Data from the multicenter randomized Coordinating study evaluating Outcomes of Advising and Counseling in Heart Failure were used. Logistic regression and mixed-effects logistic regression were used to investigate changes in appetite over time and to explore the relationship between appetite and fatigue, depressive symptoms, and quality of life.

RESULTS

A total of 734 patients with HF (mean age, 69 years) were included. Decreased appetite was present at all follow-up measurements; however, decreased appetite was significantly lower at the 1-month (odds ratio [OR], 0.43; confidence interval [CI], 0.29-0.63), 6-month (OR, 0.31; CI, 0.20-0.47), 12-month (OR, 0.22; CI, 0.14-0.34), and 18-month (OR, 0.24; CI, 0.15-0.37) follow-ups compared with baseline. Decreased appetite was associated with fatigue (OR, 3.09; CI, 1.98-4.84), depressive symptoms (OR, 1.76; CI, 1.35-2.29), and low quality of life (OR, 1.01; CI, 1.01-1.02) across all measurement points adjusted for covariates.

CONCLUSIONS

Appetite improved after discharge; however, at all time points, at least 22% of patients reported decreased appetite. Fatigue, depressive symptoms, and low quality of life are factors associated with decreased appetite. Decreased appetite is a long-standing problem in that it does not disappear spontaneously after an acute HF deterioration.

Thirst and factors associated with frequent thirst in patients with heart failure in Spain

BACKGROUND

Thirst is a troublesome symptom in patients with Heart Failure (HF) and one that might be perceived differently in different countries depending on climate, food and cultural habits. The aims of the study were to describe thirst frequency, duration and intensity and to identify factors associated with frequent thirst in outpatients with HF in a Mediterranean country.

METHODS

Data was collected in a cross-sectional study involving 302 patients diagnosed with HF (age 67±12 years, 74% male, LVEF 43%±14) in Spain on thirst frequency and duration, and thirst intensity by patient self-report (VAS, 0-100 mm). Clinical variables were collected from the medical files. Regression analysis was used to identify factors independently associated with frequent thirst.

RESULTS

Of all the patients, 143 (47%) were frequently thirsty, and their median (25^th and 75^th percentiles) thirst intensity was higher (VAS 50 mm [20-67] vs 7 [0-20], p<.001). Their thirst lasted longer compared to those who never/sometimes were thirsty (p<.001). Less treatment with angiotensin receptor blockers (Odds Ratio [OR] 2.72; 95% Confidence Interval [CI] 1.33-5.58), diuretics >40 mg/day (OR 1.92; 95% CI 1.02-3.64), depression (OR 2.99; CI 1.17-7.62), male gender (OR 1.98; CI 1.08-3.64) and worse New York Heart Association functional class (OR 1.92; 95% CI 1.05-3.52) were independently associated with frequent thirst.

CONCLUSIONS

About half of patients with HF and fluid restriction experienced frequent thirst in a Mediterranean area of Spain, and their thirst duration and intensity were significantly increased. Frequent thirst was associated with demographic, clinical and therapeutic variables. The results may help to identify patients with a higher risk of frequent thirst and might suggest therapeutic changes in order to diminish this troublesome symptom.

Racial Differences in Diuretic Efficiency, Plasma Renin, and Rehospitalization in Subjects With Acute Heart Failure

BACKGROUND

Black patients have higher rates of hospitalization for acute heart failure than other race/ethnic groups. We sought to determine whether diuretic efficiency is associated with racial differences in risk for rehospitalization after acute heart failure.

METHODS

A post hoc analysis was performed on 721 subjects (age, 68±13 years; 22% black) enrolled in 3 acute heart failure clinical trials: ROSE-AHF (Renal Optimization Strategies Evaluation in Acute Heart Failure), DOSE-AHF (Diuretic Optimization Strategy Evaluation in Acute Decompensated Heart Failure), and CARRESS-HF (Cardiorenal Rescue Study in Acute Decompensated Heart Failure). Repeated-measures ANOVA was used to test for a race×time effect on measures of decongestion. Diuretic efficiency was calculated as net fluid balance per total furosemide equivalents. In a subset of subjects, Cox regression was used to examine the association between race and rehospitalization according to plasma renin activity (PRA).

RESULTS

Compared with nonblack patients, black patients were younger and more likely to have nonischemic heart failure. During the first 72 to 96 hours, there was greater fluid loss (P=0.001), decrease in NT-proBNP (N-terminal pro-B-type natriuretic peptide; P=0.002), and lower levels of PRA (P<0.0001) in black patients. Diuretic efficiency was higher in black than in nonblack patients (403 [interquartile range, 221-795] versus 325 [interquartile range, 154-698]; P=0.014). However, adjustment for baseline PRA attenuated the association between black race and diuretic efficiency. Over a median follow-up of 68 (interquartile range, 56-177) days, there was an increased risk of all-cause and heart failure-specific rehospitalization in nonblack patients with increasing levels of PRA, while the risk of rehospitalization was relatively constant across levels of PRA in black patients.

CONCLUSIONS

Higher diuretic efficiency in black patients with acute heart failure may be related to racial differences in activity of the renin-angiotensin-aldosterone system.

Transcultural adaptation of the Thirst Distress Scale (TDS) into Brazilian Portuguese and an analysis of the psychometric properties of the scale for patients on hemodialysis

OBJECTIVE

To produce a transcultural adaptation of the Thirst Distress Scale (TDS) into Brazilian Portuguese and analyze the scale's psychometric properties for patients on hemodialysis (HD).

METHODS

The original scale was translated, back translated, and discussed with psychometric assessment experts. The final version was tested with 126 patients on HD and retested with 70 individuals from the original patient population. Cronbach's alpha was used to measure the scale's internal consistency. Reliability of thirst intensity evaluated via the visual analogue scale (VAS) was tested with Kappa statistic and the Bland-Altman plot. Reproducibility was assessed based on the intraclass correlation coefficient (ICC).

RESULTS

The wording of three items and the verb tenses of six had to be adjusted in the final version of the Brazilian Portuguese TDS. Comprehension of the scale by patients on HD was good, the scale's internal consistency was satisfactory (0.84; p<0.001), agreement with a visual analogue scale (VAS) was moderate (kappa=0.44; p<0.001), and reproducibility neared perfection (ICC=0.87; p<0.001).

CONCLUSION

Our results showed that the Brazilian Portuguese version of the scale might be used reliably. The Brazilian Portuguese version of the TDS is a practical, affordable, accessible and well-accepted tool that has a lot to offer for the management of patients with HD.

Thirst in heart failure: what do we know so far?

PURPOSE OF REVIEW

Thirst is a common and burdensome symptom of heart failure, which impacts adversely on quality of life. To date, there is limited research on the prevalence of thirst, the factors associated with thirst and interventions to help manage thirst in heart failure. This review summarizes key empirical research developments of thirst.

RECENT FINDINGS

Recent research shows that the heart failure syndrome, medications, self-care practice such as fluid restriction and anxiety contributes greatly to increased thirst in patients with heart failure. In addition, predictors such as being younger, male patient, with high symptom burden and serum urea is also associated with thirst. There are no intervention studies to manage thirst, only reports of various strategies recommended to heart failure patients in clinical practice.

SUMMARY

Despite the burden of thirst in heart failure patients, strategies to relieve thirst remains insufficiently addressed in literature. Further research to improve the understanding of the severity of thirst and its relationship to possible factors associated with thirst is required in order to develop future interventions to either prevent or alleviate troublesome thirst in patients with heart failure.

Changes in Thirst Intensity During Optimization of Heart Failure Medical Therapy by Nurses at the Outpatient Clinic

BACKGROUND

Thirst can be aggravated in patients with heart failure (HF), and optimization of HF medication can have positive impact on thirst.

OBJECTIVES

The aims of this study were to describe changes in thirst intensity and to determine factors associated with high thirst intensity during optimization of HF medication.

METHODS AND RESULTS

Patients with HF (N = 66) who were referred to an HF clinic for up-titration of HF medication were included. Data were collected during the first visit to the clinic and at the end of the treatment program. Data were dichotomized by the median visual analog scale score for thirst, dividing patients into 2 groups: low thirst intensity (0-20 mm) and high thirst intensity (>20 mm on a visual analog scale of 0-100 mm). In total, 67% of the patients reported a higher thirst intensity after the HF up-titration program. There was no difference in thirst intensity between the patients who reached target doses and those who did not. Plasma urea level (odds ratio, 1.33; 95% confidence interval, 1.07-1.65) and fluid restriction (odds ratio, 6.25; 95% confidence interval, 1.90-20.5) were independently associated with high thirst intensity in patients with HF.

CONCLUSIONS

Thirst intensity increased in two-thirds of the patients during a time period of optimization of HF medication. Fluid restriction and plasma urea levels were associated with high thirst intensity.

Trajectory of thirst intensity and distress from admission to 4-weeks follow up at home in patients with heart failure

BACKGROUND

Patients with heart failure (HF) can suffer from increased thirst intensity and distress. Trajectories of thirst intensity and distress from hospital to home are unclear. The aim of this study was to describe thirst intensity and distress trajectories in patients from the time of hospital admission to 4 weeks after discharge, and describe trajectories of thirst intensity and distress by patients' characteristics (gender, age, body mass index [BMI], plasma urea, anxiety, and depression).

PATIENTS AND METHODS

In this observational study, data were collected from patients with HF (n=30) at hospital admission, discharge, and at 2 and 4 weeks after discharge. Thirst intensity (visual analog scale, 100 mm) and distress (Thirst Distress Scale-HF, score 9-45) were used. Trajectories were examined using growth modeling.

RESULTS

Trajectory of the thirst intensity was significantly different, for patients with low and high thirst intensity levels (median cut-off 39 mm), from admission to 4 weeks follow up (thirst increased and decreased, respectively). Patients with high level of thirst distress (median score >22) at admission, having fluid restriction and women continued to have higher thirst distress over time. Patients feeling depressed had higher thirst intensity over time. There were no differences in the trajectories of thirst intensity and distress by age, BMI, plasma urea, and anxiety.

CONCLUSION

Intensity and distress of thirst, having fluid restriction, and feeling depressed at the admission were critical in predicting the trajectory of thirst intensity and distress after discharge to home in patients with HF. Effective intervention relieving thirst should be provided before their discharge to home.

Frequent drinking of small volumes improves cardiac function and survival in rats with chronic heart failure

Fluid retention is the main reason for the high hospitalization rate among patients with chronic heart failure (CHF). Given the lack of knowledge about fluid intake regulation and its consequences in patients with CHF, current guidelines do not provide clear direction for fluid management. Using a rat model of CHF, we investigated altering drinking behaviors and explored fluid management strategies. CHF was induced by ligating the left anterior descending coronary arteries in 8‐week‐old, male, Sprague‐Dawley rats. A custom‐designed drop counting and feedback control system was used to record and modulate drinking behaviors. During the first month after an induced myocardial infarction (MI), we observed that the spontaneous per drinking volume (PDV) was significantly increased in animals with prolonged intervals between drinking episodes. In addition, there was a significant inverse correlation between the early PDV and the post‐MI lifespan (r = −0.907; P < 0.001). Moreover, modulating the drinking behavior of rats with CHF to involve frequent drinking of small PDVs significantly enhanced hemodynamics and prevented cardiac remodeling, with a significant improvement in the 180‐day survival rate, compared with animals allowed to drink freely (50% vs. 36%; P < 0.01). The results of dynamic PDV changes, after MI, suggest that an impaired thirst mechanism is associated with the sensing and regulating of fluid balance in rats with CHF. These results suggest that increasing the drinking frequency, with small PDVs, may be beneficial to preventing progression of cardiac dysfunction in CHF.

Development and psychometric evaluation of the Thirst Distress Scale for patients with heart failure

BACKGROUND

Patients with heart failure can experience thirst distress. However, there is no instrument to measure this in patients with heart failure. The aim of the present study was to develop the Thirst Distress Scale for patients with Heart Failure (TDS-HF) and to evaluate psychometric properties of the scale.

METHODS AND RESULTS

The TDS-HF was developed to measure thirst distress in patients with heart failure. Face and content validity was confirmed using expert panels including patients and healthcare professionals. Data on the TDS-HF was collected from patients with heart failure at outpatient heart failure clinics and hospitals in Sweden, the Netherlands and Japan. Psychometric properties were evaluated using data from 256 heart failure patients (age 72±11 years). Concurrent validity of the scale was assessed using a thirst intensity visual analogue scale. Patients did not have any difficulties answering the questions, and time taken to answer the questions was about five minutes. Factor analysis of the scale showed one factor. After psychometric testing, one item was deleted. For the eight item TDS-HF, a single factor explained 61% of the variance and Cronbach's alpha was 0.90. The eight item TDS-HF was significantly associated with the thirst intensity score ( r=0.55, p<0.001). Regarding test-retest reliability, the intraclass correlation coefficient was 0.88, and the weighted kappa values ranged from 0.29-0.60.

CONCLUSION

The eight-item TDS-HF is valid and reliable for measuring thirst distress in patients with heart failure.

A survey of views and opinions of health professionals managing thirst in chronic heart failure

BACKGROUND

Thirst is a common and burdensome symptom of chronic heart failure (CHF) which affects adherence to self-care practices specifically fluid restriction. Despite this, there is no standard clinical practice for managing the symptom of thirst.

AIMS AND OBJECTIVES

The aim is to identify the current strategies recommended by health professionals to help relieve thirst in CHF patients and their perceived usefulness of these strategies.

METHODS

A survey was distributed to attendees of the 8th Annual Scientific Meeting of Australasian Cardiovascular Nursing College.

RESULTS

There were 42 of 70 respondents to the survey. The majority (33 of 40; 82.5%) had recommended various strategies to alleviate thirst. The most recommended strategy was ice chips (36 of 38; 94.7%). Overall, the respondents reported 'some use' in all of the strategies.

CONCLUSION

Information from this survey may help in the incorporation of thirst-relieving strategies into evidence-based guidelines; further improving the quality of care of patients.