Investigating Thirst Dimensions in Heart Failure Patients Using the Theory of Unpleasant Symptoms: A Cross-Sectional Study
,
Abstract
Background: Thirst, a distressing complication in heart failure (HF) patients, arises from factors such as vasoconstriction in the salivary glands, alterations in the sympathetic nervous system, fluid restriction, nursing care practices, and pharmacotherapy. This study aimed to explore the dimensions of thirst in HF patients using the Theory of Unpleasant Symptoms (ToUS).
Methods: A descriptive cross-sectional study was conducted on 217 HF patients admitted to hospitals affiliated with Shahid Beheshti University of Medical Sciences, namely Imam Hossein, Luqman Hakim, and Shahid Modares in Tehran, Iran, from May through November 2020. Participants were selected through purposive sampling based on inclusion criteria. Data were collected using the Demographic Survey Form (DSF), Thirst Intensity Visual Analogue Scale (TI-VAS), Thirst Frequency Scale (TFS), and Thirst Distress Scale (TDS). Descriptive and analytical statistics were employed for data analysis using SPSS (version 20).
Results: The mean ± standard deviation scores for thirst intensity and thirst distress were 47.53±26.37 (moderate level) and 25.92±8.13 (high level), respectively. A significant proportion of patients (35.9%) experienced high levels of thirst distress. Additionally, 61% of participants reported feeling thirsty almost daily over the past month, with thirst persisting throughout the day. Key predictors of thirst intensity and distress included educational level; HF class; living conditions; fluid restriction; use of angiotensin-converting enzyme inhibitors, β-blockers, aldosterone antagonists, and diuretics; and the presence of diabetes.
Conclusion: Given the high prevalence and distressing nature of thirst in HF patients, nurses should prioritize assessing thirst during care delivery. Identifying contributing factors and predicting thirst intensity during patient history-taking can enhance management strategies.
2. Rossignol P, Hernandez AF, Solomon SD, Zannad F. Heart failure drug treatment. The Lancet. 2019;393(10175):1034-1044.
3. Felker GM, Mann DL. Heart Failure E-Book: A Companion to Braunwald's Heart Disease. Elsevier Health Sciences; 2014.
4. Ifrim M, Bontaş E, Cochior D, Ţintoiu IC. Right Heart Anatomy: A Short Uptodate. Right Heart Pathology: From Mechanism to Management. 2018:25-56.
5. Shofany C. Quality of life among chronic disease patients. Nursing & Care Open Access Journal. 2017;4(2):385-94.
6. Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Kardiologia Polska (Polish Heart Journal). 2016;74(10):1037-1147.
7. Bonow RO, Mann DL, Zipes DP, Libby P. Braunwald's heart disease e-book: A textbook of cardiovascular medicine. Elsevier Health Sciences; 2011.
8. Dassanayaka S, Jones SP. Recent developments in heart failure. Circulation research. 2015;117(7):e58-e63.
9. Eisen H. Heart failure: a comprehensive guide to pathophysiology and clinical care. springer; 2017.
10. McDonagh TA, Metra M, Adamo M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) With the special contribution of the Heart Failure Association (HFA) of the ESC. European heart journal. 2021;42(36):3599-3726.
11. Palazzuoli A, Gallotta M, Quatrini I, Nuti R. Natriuretic peptides (BNP and NT-proBNP): measurement and relevance in heart failure. Vascular health and risk management. 2010;6:411.
12. Ahmadi A, Soori H, Mobasheri M, Etemad K, Khaledifar A. Heart failure, the outcomes, predictive and related factors in Iran. Journal of Mazandaran University of Medical Sciences. 2014;24(118):180-188.
13. Benjamin EJ, Muntner P, Alonso A, et al. Heart disease and stroke statistics—2019 update: a report from the American Heart Association. Circulation. 2019;139(10):e56-e528.
14. Dunlay SM, Roger VL. Understanding the epidemic of heart failure: past, present, and future. Current heart failure reports. 2014;11:404-415.
15. Rotunno R, Oppo I, Saetta G, Aveta P, Bruno S. NSAIDs and heart failure: A dangerous relationship. Monaldi Archives for Chest Disease. 2018;88(2)
16. Desai AS, Stevenson LW. Rehospitalization for heart failure: predict or prevent? Circulation. 2012;126(4):501-506.
17. Bader F, Manla Y, Atallah B, Starling RC. Heart failure and COVID-19. Heart failure reviews. 2021;26(1):1-10.
18. Comín-Colet J, Anguita M, Formiga F, et al. Health-related quality of life of patients with chronic systolic heart failure in Spain: results of the VIDA-IC study. Revista Española de Cardiología (English Edition). 2016;69(3):256-271.
19. Waldreus N, Jaarsma T, van der Wal MH, Kato NP. Development and psychometric evaluation of the Thirst Distress Scale for patients with heart failure. European Journal of Cardiovascular Nursing. 2018;17(3):226-234.
20. Eng SH, Waldréus N, González B, et al. Thirst distress in outpatients with heart failure in a Mediterranean zone of Spain. ESC heart failure. 2021;8(4):2492-2501.
21. van der Wal MH, Waldréus N, Jaarsma T, Kato NP. Thirst in patients with heart failure in Sweden, the Netherlands, and Japan. Journal of Cardiovascular Nursing. 2020;35(1):19-25.
22. Waldreus N, Chung ML, van der Wal MH, Jaarsma T. Trajectory of thirst intensity and distress from admission to 4-weeks follow up at home in patients with heart failure. Patient preference and adherence. 2018:2223-2231.
23. Eng SH, Jaarsma T, Lupón J, et al. Thirst and factors associated with frequent thirst in patients with heart failure in Spain. Heart & Lung. 2021;50(1):86-91.
24. Negro A, Villa G, Greco M, et al. Thirst in patients admitted to intensive care units: an observational study. Irish Journal of Medical Science (1971-). 2021:1-7.
25. Pierotti I, Fracarolli IFL, Fonseca LF, Aroni P. Evaluation of the intensity and discomfort of perioperative thirst. Escola Anna Nery. 2018;22
26. Wefer F, Inkrot S, Waldréus N, Jaarsma T, von Cube M, Kugler C. Translation and Psychometric Evaluation of the German Version of the Thirst Distress Scale for Patients With Heart Failure. Journal of Cardiovascular Nursing. 2022;37(4):378-385.
27. Kara B. Determinants of thirst distress in patients on hemodialysis. International urology and nephrology. 2016;48:1525-1532.
28. Porcu M, Fanton E, Zampieron A. Thirst distress and interdialytic weight gain: a study on a sample of haemodialysis patients. Journal of renal care. 2007;33(4):179-181.
29. Schooling CM, Jones HE. Clarifying questions about “risk factors”: predictors versus explanation. Emerging themes in epidemiology. 2018;15(1):1-6.
| Files | ||
| Issue | Vol 19 No S1 (2024): Supplementary 1 | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/jthc.v19is1.18473 | |
| Keywords | ||
| Thirst Heart Failure Theory of Unpleasant Symptoms patient | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
