Background: Acute decompensated heart failure (ADHF) is a worsening symptom of heart failure (HF) that usually causes re-hospitalization, high healthcare costs, and mortality in adults. Diuretic treatment and fluid control education are necessary to improve hemodynamics and reduce excessive body fluid. However, these actions along with the pathophysiology of ADHF may increase the perception of thirst, increase body weight (BW), decrease sleep quality, and trigger depression symptoms in patients.
Purpose: To investigate the effectiveness of a fluid control education intervention to improve thirst, BW change, sleep quality, and depression symptoms in patients with ADHF three months after the intervention.
Method: A randomized control trial design on the Consolidated Standard of Reporting Trials (CONSORT) 2020 guidelines was employed. The convenience sampling technique was used to recruit 33 participants in the cardiovascular ward at a medical center in Southern Taiwan. Seventeen participants were randomly assigned to the intervention group (IG), and sixteen to the usual care group (UCG). The IG received fluid control education intervention including (1) a small amount (less than 100ml per time) of water drink; (2) self-monitoring of body weight and perception of thirst and (3) patient education and support. Whereas UCG received usual routine care. Both groups were followed-up on the first day of admission, before discharge, 1 month, and three months after discharge. The instruments included, the thirst distress Scale of HF (TDS-HF), the Richards-Campbell sleep questionnaire (RCSQ) (in hospital), the Pittsburgh sleep quality index (PSQI) (after discharge), and the patient health questionnaire-9 (PHQ-9).
Analysis: Descriptive data including frequency, percentage, median, mean, standard deviation, and range were used to describe the demographic and illness-related factors in IG and UCG. Chi-square and Mann-Whitney U-test were used to assess the differences between groups. The linear mixed effect model was used to analyze the changes over time in thirst, body weight change, sleep quality, and depression symptoms.
Result: The mean age for the IG was 63.2 years (SD=11.4) and the UCG was 64.2 years (SD=12.9). IG suffered 8.5 years of HF and UCG suffered 6.5 years. IG and UCG had an identical mean of LVEF (35.9±17.0 and 35.5±16.2). Most IG (82.4%) and UCG (100%) participants took diuretics tablets, moreover, IG (76.5%) and UCG (81.3%) also used intravenous diuretics. Regarding demographic illness-related factors, hypertension, diabetes mellitus, and ACE inhibitors were significantly different between IG and UCG. The linear mixed model showed no interaction effect in all variables, including the TDS-HF (F = 1.43, p = .240), thirst distress (F = 1.33, p = .269), thirst intensity score (F = 0.45, p = .718), body weight (F = 0.12 , p = .950), body weight change (F = 0.95, p = .420), RCSQ (F = 0.13, p = .722), PHQI (F = 0.04, p = .847), and PHQ-9 (F = 0.12, p = .890).
Conclusion: The fluid control education intervention was not significantly improved thirst, body weight change, sleep quality, and depression symptoms in patients with ADHF.

Keywords: Acute decompensated heart failure, fluid control education intervention, thirst, body weight, sleep quality, depression symptoms.

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