{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T17:06:25Z","timestamp":1788973585058,"version":"build-2803163510"},"reference-count":16,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:00:00Z","timestamp":1785283200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004344","name":"Dutch Heart Foundation","doi-asserted-by":"publisher","award":["2019T100"],"award-info":[{"award-number":["2019T100"]}],"id":[{"id":"10.13039\/501100004344","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100006209","name":"Radboud University Medical Centre in Nijmegen","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100006209","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004528","name":"Maastricht University Medical Centre","doi-asserted-by":"publisher","award":["R0005106"],"award-info":[{"award-number":["R0005106"]}],"id":[{"id":"10.13039\/501100004528","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,27]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aims<\/jats:title>\n                    <jats:p>The Fluid REStriction in Heart failure versus liberal fluid UPtake (FRESH-UP) study (NCT04551729) randomized patients with chronic heart failure (HF) to liberal fluid intake (LFI) vs fluid restriction (FR). Pre-trial fluid management may have impacted trial outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The open-label FRESH-UP study randomized 504 patients with chronic HF to an advice of LFI or FR of 1500\u2005ml\/day. Primary outcome was the Kansas City Cardiomyopathy Questionnaire Overall Summary Score (KCCQ-OSS) after 3 months adjusted for baseline. Key secondary outcome was thirst distress. Patient-reported fluid intake was assessed at Week 6. Safety outcomes included death and hospitalizations. For this subanalysis, participants were stratified according to pre-trial fluid management (FR or LFI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Prior to randomization, 269 (53.4%) patients adhered to FR and 235 (46.6%) adhered to LFI. After 3 month follow-up, KCCQ-OSS was significantly different between groups (P = .035): in patients changing from pre-trial FR to LFI, KCCQ-OSS was 74.7 [95% confidence interval (CI) 71.2\u201378.3] compared to 70.2 (95% CI 66.3\u201374.2) in those with the reversed scenario. In the latter group, thirst distress increased the most. Patient-reported fluid intake was significantly higher in patients randomized to LFI when compared to FR (P = .019), regardless of pre-trial FR or LFI (1771 and 1757\u2005ml, vs 1486 and 1464\u2005ml, respectively). Safety outcomes did not differ.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>These analyses add understanding to the effects of fluid intake management in chronic HF and expose a signal of potential harm of FR in patients with pre-trial LFI and a potential benefit of LFI in patients with pre-trial FR. These results corroborate with the primary results and support that there is no need to routinely initiate or continue FR in stable patients with chronic HF.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/eschf\/xvag197","type":"journal-article","created":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T11:22:20Z","timestamp":1785151340000},"source":"Crossref","is-referenced-by-count":0,"title":["The effect of a change in fluid intake advice on outcomes in chronic heart failure: a prespecified subanalysis of the FRESH-UP study"],"prefix":"10.1093","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5923-3720","authenticated-orcid":false,"given":"Job J","family":"Herrmann","sequence":"first","affiliation":[{"name":"Department of Cardiology, Radboud University Medical Centre , Geert Grooteplein 10, P.O. Box 9101, Nijmegen, 6525 GA ,","place":["The Netherlands"]},{"name":"Netherlands Heart Institute , Utrecht ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4356-8566","authenticated-orcid":false,"given":"Hans-Peter","family":"Brunner-La Rocca","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Maastricht University Medical Center , Maastricht ,","place":["The Netherlands"]},{"name":"Cardiovascular Research Institute Maastricht (CARIM), Maastricht University , Maastricht ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisette E H J M","family":"Baltussen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Radboud University Medical Centre , Geert Grooteplein 10, P.O. Box 9101, Nijmegen, 6525 GA ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabienne","family":"Beckers-Wesche","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Maastricht University Medical Center , Maastricht ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastiaan C A M","family":"Bekkers","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Bernhoven Hospital , Uden ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louise","family":"Bellersen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Radboud University Medical Centre , Geert Grooteplein 10, P.O. Box 9101, Nijmegen, 6525 GA ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J W Martijn","family":"Van Eck","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Jeroen Bosch Hospital , \u2018s-Hertogenbosch ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H Carlijne","family":"Hassing","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Radboud University Medical Centre , Geert Grooteplein 10, P.O. Box 9101, Nijmegen, 6525 GA ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4197-4026","authenticated-orcid":false,"given":"Tiny","family":"Jaarsma","sequence":"additional","affiliation":[{"name":"Department of Health, Medicine and Caring Sciences, Faculty of Medical and Health, Link\u00f6ping University , Link\u00f6ping ,","place":["Sweden"]},{"name":"Department of Cardiology, University Medical Center Utrecht , Utrecht ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerard C M","family":"Linssen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hospital Group Twente , Almelo\/Hengelo ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8965-0664","authenticated-orcid":false,"given":"Ron","family":"Pisters","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Rijnstate Hospital , Arnhem ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra","family":"Sanders-Van Wijk","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Zuyderland Medical Center , Henri Dunantstraat 5, Heerlen, 6419 PC ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marjolein H I","family":"Verdijk","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Radboud University Medical Centre , Geert Grooteplein 10, P.O. Box 9101, Nijmegen, 6525 GA ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2706-9326","authenticated-orcid":false,"given":"Laura","family":"Rodwell","sequence":"additional","affiliation":[{"name":"IQ Health Department, Radboud University Medical Center , Nijmegen ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roland R J","family":"van Kimmenade","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Radboud University Medical Centre , Geert Grooteplein 10, P.O. Box 9101, Nijmegen, 6525 GA ,","place":["The Netherlands"]},{"name":"Department of Cardiology, Zuyderland Medical Center , Henri Dunantstraat 5, Heerlen, 6419 PC ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D H Frank","family":"Gommans","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Radboud University Medical Centre , Geert Grooteplein 10, P.O. Box 9101, Nijmegen, 6525 GA ,","place":["The Netherlands"]},{"name":"Department of Cardiology, M\u00e1xima Medical Center , Veldhoven ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,7,29]]},"reference":[{"key":"2026090911561066000_xvag197-B1","doi-asserted-by":"publisher","first-page":"2062","DOI":"10.1038\/s41591-025-03628-4","article-title":"Liberal fluid intake versus fluid restriction in chronic heart failure: a randomized clinical trial","volume":"31","author":"Herrmann","year":"2025","journal-title":"Nat Med"},{"key":"2026090911561066000_xvag197-B2","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.cardfail.2012.11.007","article-title":"A randomized controlled pilot study of outcomes of strict allowance of fluid therapy in hyponatremic heart failure (SALT-HF)","volume":"19","author":"Albert","year":"2013","journal-title":"J Card Fail"},{"key":"2026090911561066000_xvag197-B3","doi-asserted-by":"publisher","first-page":"316","DOI":"10.1080\/14017430802071200","article-title":"Liberal versus restricted fluid prescription in stabilised patients with chronic heart failure: result of a randomised cross-over study of the effects on health-related quality of life, physical capacity, thirst and morbidity","volume":"42","author":"Holst","year":"2008","journal-title":"Scand Cardiovasc J"},{"key":"2026090911561066000_xvag197-B4","doi-asserted-by":"publisher","first-page":"128","DOI":"10.1016\/j.cardfail.2006.10.012","article-title":"Fluid restriction in the management of decompensated heart failure: no impact on time to clinical stability","volume":"13","author":"Travers","year":"2007","journal-title":"J Card Fail"},{"key":"2026090911561066000_xvag197-B5","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2025-326784","article-title":"Fluid restriction in patients with heart failure: a systematic review","author":"Herrmann","year":"2026","journal-title":"Heart"},{"key":"2026090911561066000_xvag197-B6","doi-asserted-by":"publisher","first-page":"1522","DOI":"10.1016\/j.cardfail.2022.05.015","article-title":"Fluid REStriction in heart failure vs liberal fluid UPtake: rationale and design of the randomized FRESH-UP study","volume":"28","author":"Herrmann","year":"2022","journal-title":"J Card Fail"},{"key":"2026090911561066000_xvag197-B7","doi-asserted-by":"publisher","first-page":"2379","DOI":"10.1016\/j.jacc.2020.09.542","article-title":"Interpreting the Kansas city cardiomyopathy questionnaire in clinical trials and clinical care: JACC state-of-the-art review","volume":"76","author":"Spertus","year":"2020","journal-title":"J Am Coll Cardiol"},{"key":"2026090911561066000_xvag197-B8","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1001\/jamacardio.2024.4470","article-title":"Interpreting population mean treatment effects in the Kansas city cardiomyopathy questionnaire: a patient-level meta-analysis","volume":"10","author":"Abdel Jawad","year":"2025","journal-title":"JAMA Cardiol"},{"key":"2026090911561066000_xvag197-B9","doi-asserted-by":"publisher","DOI":"10.3390\/nu12113383","article-title":"Fluid intake recommendation considering the physiological adaptations of adults over 65 years: a critical review","volume":"12","author":"Masot","year":"2020","journal-title":"Nutrients"},{"key":"2026090911561066000_xvag197-B10","author":"Knowledge4Policy"},{"key":"2026090911561066000_xvag197-B11","volume-title":"The Diet of the Dutch. Results of the Dutch National Food Consumption Survey 2019-2021 on Food Consumption and Evaluation with Dietary Guidelines","author":"van Rossum","year":"2023"},{"key":"2026090911561066000_xvag197-B12","doi-asserted-by":"publisher","first-page":"1870","DOI":"10.1001\/jama.2018.4930","article-title":"Effect of coaching to increase water intake on kidney function decline in adults with chronic kidney disease: the CKD WIT randomized clinical trial","volume":"319","author":"Clark","year":"2018","journal-title":"JAMA"},{"key":"2026090911561066000_xvag197-B13","doi-asserted-by":"publisher","first-page":"370","DOI":"10.1093\/fampra\/cmr112","article-title":"A randomized trial on the effects of regular water intake in patients with recurrent headaches","volume":"29","author":"Spigt","year":"2012","journal-title":"Fam Pract"},{"key":"2026090911561066000_xvag197-B14","doi-asserted-by":"publisher","first-page":"730","DOI":"10.1002\/ejhf.3244","article-title":"Dietary sodium and fluid intake in heart failure. A clinical consensus statement of the Heart Failure Association of the ESC","volume":"26","author":"Mullens","year":"2024","journal-title":"Eur J Heart Fail"},{"key":"2026090911561066000_xvag197-B15","doi-asserted-by":"publisher","first-page":"669","DOI":"10.1161\/CIRCHEARTFAILURE.111.961789","article-title":"Sympathetically mediated changes in capacitance: redistribution of the venous reservoir as a cause of decompensation","volume":"4","author":"Fallick","year":"2011","journal-title":"Circ Heart Fail"},{"key":"2026090911561066000_xvag197-B16","doi-asserted-by":"publisher","first-page":"825","DOI":"10.1113\/expphysiol.1991.sp003549","article-title":"Capillary filtration-absorption balance reconsidered in light of dynamic extravascular factors","volume":"76","author":"Levick","year":"1991","journal-title":"Exp Physiol"}],"container-title":["ESC Heart Failure"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/eschf\/advance-article-pdf\/doi\/10.1093\/eschf\/xvag197\/70333165\/xvag197.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/eschf\/article-pdf\/13\/5\/xvag197\/70333165\/xvag197.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/eschf\/article-pdf\/13\/5\/xvag197\/70333165\/xvag197.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T16:06:24Z","timestamp":1788969984000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/eschf\/article\/doi\/10.1093\/eschf\/xvag197\/8746616"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,29]]},"references-count":16,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,7,29]]},"published-print":{"date-parts":[[2026,8,27]]}},"URL":"https:\/\/doi.org\/10.1093\/eschf\/xvag197","relation":{},"ISSN":["2055-5822"],"issn-type":[{"value":"2055-5822","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,10]]},"published":{"date-parts":[[2026,7,29]]},"article-number":"xvag197"}}