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Changes in Thirst Intensity During Optimization of Heart Failure Medical Therapy by Nurses at the Outpatient Clinic.
Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care.
Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Department of Research, Södertälje Sjukhus, Södertälje, Sweden.
Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden.
Department of Cardiology, University of Groningen, University Medical Center Groningen, the Netherlands.
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2015 (English)In: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 31, no 5, E17-E24 p.Article in journal (Refereed) Epub ahead of print
Abstract [en]

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.

Place, publisher, year, edition, pages
Wolters Kluwer, 2015. Vol. 31, no 5, E17-E24 p.
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:liu:diva-125914DOI: 10.1097/JCN.0000000000000319PubMedID: 26696035OAI: oai:DiVA.org:liu-125914DiVA: diva2:910033
Available from: 2016-03-08 Created: 2016-03-08 Last updated: 2016-08-25Bibliographically approved
In thesis
1. Thirst in Patients with Heart Failure: Description of thirst dimensions and associated factors with thirst
Open this publication in new window or tab >>Thirst in Patients with Heart Failure: Description of thirst dimensions and associated factors with thirst
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Introduction: Nurses and other health care professionals meet patients with heart failure (HF) who report they are thirsty. Thirst is described by the patients as a concern, and it is distressing. Currently there are no standardized procedures to identify patients with increased thirst or to help a patient to manage troublesome thirst and research in the area of thirst is scarce. In order to prevent and relieve troublesome thirst more knowledge is needed on how thirst is experienced and what factors cause increased thirst.

Aim: The aim of this thesis was to describe the thirst experience of patients with HF and describe the relationship of thirst with physiologic, psychologic and situational factors. The goal was to contribute to the improvement of the care by identifying needs and possible approaches to prevent and relieve thirst in patients with HF.

Methods: The studies in this thesis used a cross-sectional design (Study I) and prospective observational designs (II-IV). Studies include data from patients with HF who were admitted to the emergency department for deterioration in HF (I, IV) or visited an outpatient HF clinic for worsening of HF symptoms (III); others were patients who were following up after HF hospitalization (II), and patients with no HF diagnosis who sought care at the emergency department for other illness (I). Patients completed questionnaires on thirst intensity, thirst distress, HF self-care behaviour, feeling depressive and feeling anxious. Data on sociodemographic, clinical characteristics, pharmacological treatment and prescribed fluid restriction were retrieved from hospital medical records and by asking the patients. Data were also collected from blood, urine and saliva samples to measure biological markers of dehydration, HF severity and stress.

Results: Thirst was prevalent in 1 out of 5 patients (II) and 63% of patients with worsening of HF symptoms experienced moderate to severe thirst distress at hospital admission (IV). Patients at an outpatient HF clinic who reported thirst at the first visit were more often thirsty at the follow-up visits compared to patients who did not report thirst at the first visit (II). Thirst intensity was significantly higher in patients hospitalized with decompensated HF compared to patients with no HF (median 75 vs. 25 mm, visual analogue scale [VAS] 0-100 mm; P < 0.001) (I). During optimization of pharmacological treatment of HF, thirst intensity increased in 67% of the patients. Thirst intensity increased significantly more in patients in the high thirst intensity group compared to patients in the low thirst intensity group (median +18 mm vs. -3 mm; P < 0.001) (III). Patients who were admitted to the hospital with high thirst distress continued to have high thirst distress over time (IV). A large number of patients were bothered by thirst and feeling dry in the mouth when they were thirsty (III, IV). Patients with a fluid restriction had high thirst distress over time and patients who were feeling depressed had high thirst intensity over time (IV). Thirst was associated with fluid restriction (III-IV), a higher serum urea (IIIII), and depressive symptoms (II).

Conclusions: A considerable amount of patients with HF experiences thirst intensity and thirst distress. Patients who reported thirst at the first follow-up more often had thirst at the subsequent follow-ups. The most important factors related to thirst intensity or thirst distress were a fluid restriction, a higher plasma urea, and depressive symptoms. Nurses should ask patients with HF if they are thirsty and measure the thirst intensity and thirst distress, and ask if thirst is bothering them. Each patient should be critically evaluated if a fluid restriction really is needed, if the patient might be dehydrated or needs to be treated for depression.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2016. 89 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1514
Keyword
Heart failure, thirst, fluid restriction, thirst intensity, thirst distress, thirst frequency, thirst quality, dehydration, symptom management
National Category
Nursing Cardiac and Cardiovascular Systems Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-126151 (URN)10.3384/diss.diva-126151 (DOI)978-91-7685-808-0 (Print) (ISBN)
Public defence
2016-04-18, K3, Kåkenhus, Campus Norrköping, Norrköping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2016-03-15 Created: 2016-03-15 Last updated: 2016-03-15Bibliographically approved

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The full text will be freely available from 2016-12-21 12:11
Available from 2016-12-21 12:11

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