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. 2023 May 29;10(8):4948–4958. doi: 10.1002/nop2.1818

Thirst in heart failure: A scoping review

Yaya Chen 1,2,✉, Jin Ding 3, Yingbo Xi 3, Minfeng Huo 4, Yingjian Mou 2, Yu Song 1, Hailing Zhou 1,3, Xiaoqin Cui 1
PMCID: PMC10333895  PMID: 37247329

Abstract

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.

Keywords: fluid restriction, heart failure, intervention, self‐care, symptom management, thirst

1. INTRODUCTION

Heart failure (HF) is the end stage of various cardiovascular diseases, characterised by high morbidity, mortality and cost, affecting over 64 million people worldwide (Savarese et al., 2023; Waldréus et al., 2014; Wang et al., 2019). HF incidence in adults is between 1% and 3% (Savarese et al., 2023). HF is often accompanied by symptoms such as dyspnoea, fatigue and oedema (Allida et al., 2016). Recent studies have shown that thirst is another common symptom in patients with HF (Allida et al., 2016; Gong et al., 2022; Heidenreich et al., 2022). Diuretics and fluid restriction are commonly used to treat congestive symptoms in patients with HF (Seth et al., 2017). However, frequent thirst not only affects the mood of patients, but also causes patients to not comply with drug treatment and fluid restriction, which aggravates the symptoms of HF and leads to the deterioration of patients' condition and the reduction in their quality of life (Seth et al., 2017; van der Wal et al., 2010). Therefore, medical staff should pay attention to thirst in patients with heart failure (tHF).

Thirst is a strong desire to drink and is regulated by plasma volume and body fluid osmolality (Waldréus et al., 2013). Thirst is a common disturbing symptom in patients with HF, assessed in four dimensions: intensity, distress, duration and frequency (van der Wal et al., 2020). Although there are many mechanisms of tHF, the most important one is related to the regulation disorder of neuroendocrine hormones in the body (Hou et al., 2021). The reduction in effective circulating blood volume in patients with HF activates neurohormones, increases the secretion of angiotensin and antidiuretic hormone, and stimulates the hypothalamus to produce thirst (Hou et al., 2021).

Currently, recommended strategies for relieving tHF by medical professionals include—the use of ice chips or cubes, gum, sip, mints, frozen fruits in trays, lemonade and artificial saliva, gargling and brushing teeth (Allida et al., 2016; Thapa et al., 2021; van der Wal et al., 2020). In addition, there are several interventional studies on tHF, including ice water replacement of warm water (Jia et al., 2020), providing frozen strawberries (Hudiyawati & Suswardany, 2021), or chewing gum (Allida et al., 2020; Hou et al., 2021), use of saliva substitute (Robb, 2016) and traditional Chinese medicine nursing techniques (Lao & Huang, 2020; Wang & Zhou, 2019; Ye et al., 2017; Zhou et al., 2022); however, there is a lack of summary articles on knowledge about tHF. Although a review of tHF has been published in recent years, the most recent article was published 4 years ago, in which only a few databases were searched and only English articles were included (Allida et al., 2018; Allida, Inglis, Davidson, Lal, et al., 2015; Allida, Inglis, Davidson, Newton, et al., 2015; Waldréus et al., 2013). Therefore, with the increase in related studies on tHF, it is particularly important to summarise and update the relevant knowledge present.

This scoping review examined a large number of articles related to tHF and was conducted to (a) understand tHF incidence in various countries; (b) explore factors related to tHF; and (c) summarise the available intervention measures for tHF.

2. THE REVIEW

This article is a scoping review.

3. AIMS

The aim of this study was to summarise the overall picture of research related to tHF and identify the knowledge gap in this field.

4. METHODS

4.1. Study design

This scoping review is based on the six‐stage methodology of Arksey and O'Malley framework (Arksey & O'Malley, 2005) with the PAGER framework (Bradbury‐Jones et al., 2021) for scoping review, using the PRISMA‐ScR checklist (Appendix S1; Tricco et al., 2018) for scoping reporting.

4.2. Methods and research strategy

4.2.1. Stage 1: Identifying the research question

We examined the following research questions: (a) What is the incidence of tHF in various countries? (b) What factors are related to tHF? (c) What interventions are available for patients with tHF?

4.2.2. Stage 2: Identifying relevant studies

We searched the following databases for relevant articles: 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, BASEL Bielefeld Academic Search Engine), conferences or articles (Scopus, Microsoft Academic), graduate theses databases (eTHOS, DART Europe, Worldcat, EBSCO Open Dissertations) and government information media (UK guidance and regulations, USA government websites, EU Bookshop, UN official publications) were searched.

Finally, the references of relevant systematic reviews in the included studies were manually searched for additional data sources.

A search strategy was developed with the assistance of a librarian (LIU Chun). Appropriate keywords were selected using the Medical Subject Headings (MeSH) and free terms, including ‘heart failure’, ‘thirst’, ‘dry mouth’, ‘fluid restriction’, ‘intervention’, ‘self‐care’, ‘symptom management’ and ‘chewing gum’. The Boolean operators ‘AND’ and ‘OR’ were used to combine search terms. The detailed search strategy is presented in Appendix S2.

4.2.3. Stage 3: Study selection

The inclusion criteria comprised: (a) HF diagnosis; (b) thirst as a primary or secondary outcome indicator; (c) statements about HF and thirst in the article; (d) no limitation on the article type: quantitative, qualitative or mixed research; (e) publication in English or Chinese language; (f) publication date from establishment to 18 August 2022. Patients with thirst caused by impairment of salivary glands, leading to hyposalivation, such as those with Sjögren's syndrome, were excluded.

All search results were imported into Endnote X7.2 (Clarivate Analytics), and duplicates were removed. The title, abstract and complete text of the articles were screened independently by two researchers (SY and ZHL), and articles irrelevant to the research topic based on the inclusion and exclusion criteria were removed. In case of disagreements, a third researcher (XYB) was requested to make a decision.

4.2.4. Stage 4: Data charting

We developed a data extraction table for this study following the methodological framework of Arksey and O'Malley (2005). The following information was extracted: author, year, country, purpose, design, sample size, patient characteristics, incidence of thirst, thirst‐related factors, thirst treatment measures, intervention time, related indicators and findings. This process was performed separately by two authors (SY and ZHL) who are proficient in both English and nursing, and the results were finally cross‐checked so that the original interpretation remained unchanged after the translation of Chinese content into English to ensure accuracy and consistency of the extracted data.

4.2.5. Stage 5: Collating, summarising and reporting the results

Descriptive numerical summary analysis was used to report the characteristics of the included studies, which has been presented in table form (Appendix S3) (Arksey & O'Malley, 2005). The PAGER (Patterns, Advances, Gaps, Evidence for practice and Research recommendations) framework proposed by Bradbury‐Jones et al. (2021) is a structured method for analysing and reporting review findings and is also a supplement to Arksey and O′Malley's Stage 5 process, which can achieve better reporting and greater clarity (Bradbury‐Jones & Aveyard, 2021). A useful starting point of the PAGER framework is to produce a patterning chart. This is essentially a table of key themes, and the themes arise from what is typically an inductive, thematic analysis of the key findings from each included article in the review (Bradbury‐Jones & Aveyard, 2021), according to the objective of the review, finding the gap in the research, deducing clear and specific recommendations for future research and making recommendations for practice in the end. Under the PAGER framework, three themes were finally summarised, including the incidence, related factors of tHF and the interventions for tHF (Table 1).

TABLE 1.

Illustration of the PAGER framework.

Pattern Advances Gaps Evidence for practice Research recommendations
Incidence of tHF There has been an increase in studies of the incidence of tHF The incidence of tHF has been studied mainly in Spain, China, America, India and Sweden, but not in other countries Further studies on the incidence of tHF in other countries are needed Further research is needed to understand the incidence of tHF in different countries
Related factors of tHF There is a growing literature on factors associated with tHF There are few longitudinal studies on tHF; No studies on factors that promote or hinder tHF

Although there are many cross‐sectional surveys on thirst‐related factors in patients with HF, longitudinal studies are needed to increase the stability of the results

It is necessary to distinguish the factors hindering and promoting tHF

 Multi‐dimensional (cross‐sectional and longitudinal) studies are needed to identify factors associated with tHF; More attention should be paid to the factors promoting tHF
Intervention measures for tHF There is a growing literature on interventions for tHF Limited thirst recommendation strategies (use of artificial saliva, ice cubes, mouthwash, peppermint, cheese, cucumber, coconut water and isotonic drinks, and brushing teeth) are used in patients with heart failure and thirst; There are few qualitative studies on intervention measures for tHF Evidence to emerge from future research It is necessary to determine the effectiveness of thirst recommendation strategies in tHF through a randomised controlled study
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4.2.6. Stage 6: Consultation

We did not perform any consultations, which is an optional stage in scoping reviews (Arksey & O'Malley, 2005), due to various limitations.

5. RESULTS

5.1. Search results

We retrieved 825 articles (Figure 1), of which 416 remained after removing the duplicates. Subsequently, we excluded 383 articles after reading the title and abstract, and nine after reading the complete text (see Appendix S3 for details on the excluded articles and reasons for their exclusion). Two articles were added after reading the reference lists of the remaining 24 articles. Ultimately, 26 articles were included in this study.

FIGURE 1.

FIGURE 1

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PRISMA flow diagram.

5.2. Characteristics of the included studies

Table S1 summarises the relevant characteristics of the 26 included studies, which comprised 10 randomised controlled studies, one prospective, randomised, single‐blinded crossover study, nine descriptive cross‐sectional studies, four literature reviews, one a quasi‐experimental study and one a case–control study. These studies were conducted in China (n = 11), Sweden (n = 5), Australia (n = 3), Spain (n = 2), USA (n = 1), India (n = 1), Indonesia (n = 1), in a multiple centres in North America, Sweden, Brazil and the Netherlands (n = 1), and in multiple centres in Sweden, the Netherlands and Japan (n = 1). Most included studies had been published in the past 5 years (n = 17, 68%).

Excluding the studies by Allida et al. (2018) and Shi et al. (2016), the total included population was 17,038, of whom, 69.2% were male, and 4.0% were outpatients. The patients' age ranged between 20 and 88 years, the disease duration was 1–20 years, and the left ventricular ejection fraction was 18%–61%.

Only one study (Holst et al., 2008) regarded thirst as a secondary outcome indicator in patients with HF. Twelve studies mentioned thirst interventions in patients with HF, seven mentioned factors associated with thirst, four mentioned incidence of tHF and thirst‐related factors, two mentioned thirst‐related factors and intervention measures, and one mentioned thirst incidence, related factors and interventions in patients with HF.

5.3. Findings of the review

The three themes summarised from the 26 included studies were incidence, related factors and intervention measures for tHF.

5.3.1. Incidence of tHF

Five studies reported on the incidence of tHF, which was generally high but varied from country to country. Two studies were from China (Beijing and Dalian; Liu et al., 2022; Su, 2014), with a tHF incidence of 88.6% (n = 121) and 83.2% (n = 187), respectively; one was from Spain (Eng, Waldréus, et al., 2021), with a tHF incidence of 47.0% (n = 302); one was from India (Thapa et al., 2021), with a tHF incidence of 66.7% (n = 75); and one was a multicentre study from the Netherlands (Waldréus et al., 2014), with a tHF incidence of 34.0% (n = 135).

5.3.2. Related factors of tHF

Fourteen studies related to tHF were classified according to the following five categories: demograpic, HF‐related and medication factors, self‐care practices and emotions.

Demographic factors

Sex, age and body mass index (BMI) may be related to tHF. Reports suggest (Allida et al., 2018; Eng, Jaarsma, et al., 2021; Waldréus et al., 2014) that men with HF are more likely to feel thirsty than women. However, the report by Waldréus, Chung, et al. (2018) showed a different view. Women's thirst distress was higher than that of men’. Patients with persistent thirst were younger than those without (Waldréus et al., 2014), and the study by Waldréus, Jaarsma, et al. (2018) indicated that age had no influence on the intensity of thirst and pain trajectory of patients with HF. In addition, a study showed that higher BMI can increase the risk of tHF (Waldréus et al., 2014); however, another study showed that BMI is not related to tHF (Waldréus, Jaarsma, et al., 2018).

Factors related to heart failure

Heart failure, cardiac function grading, serum urea, fluid intake and output, plasma volume, degree of oedema, glomerular filtration rate and degree of dyspnoea may be related to tHF. It has been reported (Waldréus et al., 2011) that older patients with HF become thirstier than those without. The higher the cardiac function grade, the thirstier patients with HF become (Liu et al., 2022; Reilly et al., 2010; Shi et al., 2016; Su, 2014; Waldréus et al., 2013, 2014; Wang et al., 2019). Reports suggest (Thapa et al., 2021; Waldréus et al., 2014) that high serum urea can increase the risk of tHF. However, some studies have shown that serum urea is not related to tHF (Waldréus, Jaarsma, et al., 2018). One study (Su, 2014) reported that the 24‐h liquid balance and intake were negatively correlated with the degree of thirst, whereas the degree of dyspnoea and 24‐h liquid output were positively correlated with the degree of thirst (p < 0.05). Plasma volume, oedema and glomerular filtration rate have also been reported as related factors affecting tHF (p < 0.05) (Wang et al., 2019).

Medication factors

Diuretics, tolvaptan, angiotensin II receptor antagonists and angiotensin‐converting enzyme inhibitors may be related to tHF. Diuretics can increase tHF (Allida et al., 2018; Eng, Waldréus, et al., 2021; Liu et al., 2022; Shi et al., 2016; Su, 2014; Waldréus et al., 2013). The most common adverse reaction of antidiuretic hormone receptor antagonist tolvaptan is thirst (Konstam et al., 2007). Angiotensin II receptor antagonists and angiotensin‐converting enzyme inhibitors can reduce tHF (Sica, 2001).

Self‐nursing practice

Fluid restriction is the main self‐care method for patients with HF (Allida et al., 2018). At present, the research results on whether fluid restriction aggravates tHF are inconsistent. Some studies have shown that strict liquid limits are beneficial. After 60 days of strict restriction on liquid intake, the patient's quality of life was improved without severe thirst (Albert et al., 2013). Fluid restriction in patients with moderate to severe chronic HF (CHF) does not worsen thirst (Philipson et al., 2010). However, Travers et al. (2007) pointed out that strict liquid restriction would make patients thirsty.

Emotions

Emotions are related to tHF. The most common negative emotions in patients with HF are depression and anxiety (Brannstrom et al., 2006; Eng, Jaarsma, et al., 2021; Eng, Waldréus, et al., 2021), and more than 20% of patients have experienced depression (Hare et al., 2014). Anxiety and depression have been reported to cause reduced salivary secretion, leading to dry mouth, while enhancing the sensitivity to existing symptoms, including increased thirst (Gholami et al., 2017). In addition, the severe psychological pressure of thirst in patients, in turn, increases their risk of anxiety and depression (Katon et al., 2001).

5.3.3. Intervention measures for tHF

Fifteen of the 26 studies discussed interventions and mitigation strategies for tHF. Interventions mainly included the use of chewing gum (Allida et al., 2021; Hou et al., 2021), saliva substitute (Robb, 2016), frozen strawberries (Hudiyawati & Suswardany, 2021), lemon water spray (Bai et al., 2022), liquid intake recommended based on body weight (Holst et al., 2008), acupoint massage (Lao & Huang, 2020; Pan et al., 2022), ear‐point pressing beans (Hou et al., 2021; Wang & Zhou, 2019), ginseng plum decoction (Pan et al., 2022), black plum soup (Zhang et al., 2021) and improved five‐juice drink (Xi et al., 2022). Suggested mitigation strategies included the use of artificial saliva, mouthwash, cucumber, mint, ice cubes, frozen fruits in ice cubes, a small amount of water, buttermilk, coconut water and isotonic drinks, and brushing teeth (Allida et al., 2016; Allida, Inglis, Davidson, Newton, et al., 2015; Shi et al., 2016; Thapa et al., 2021; van der Wal et al., 2020).

6. DISCUSSION

Thirst is one of the most troublesome symptoms for patients with HF, which seriously affects their quality of life and cannot be ignored. The results of this review showed that the incidence of thirst is the highest in Chinese patients with HF, and the lowest in those in the Netherlands. This may be related to the following reasons: (a) The diet of Beijing and Dalian residents in China is associated with the northern taste (fresh and salty); in contrast, the Dutch diet is mainly sour and sweet. (b) Dalian, China, has a mild climate and humid air; Spain, on the contrary, has a Mediterranean climate with sufficient sunshine, and a long and hot summer. (c) There are differences between the medical policies and cultures in various countries. Although this study is reported from an international perspective, the current research on the incidence of tHF is limited. Therefore, more attention should be paid in future research to the incidence of thirst in other countries, so as to have a comprehensive understanding of it.

The current research has not been able to determine the relationship between thirst and sex, age and BMI in patients with HF. Eng, Jaarsma, et al. (2021) showed that male patients with HF were more likely to feel thirsty than female patients, which may be related to the high proportion of male patients in the study (n = 302, 74%), or because, from a physiological perspective, males are more prone to dehydration than females, thus, leading to increased thirst in males (Hahn & Waldréus, 2013; Waldréus et al., 2013). On the one hand, this finding may be because this was a longitudinal study from admission to home follow‐up for 4 weeks, with a longer duration and more robust research results. On the other hand, it may be related to the more obvious symptoms of dry mouth and pain in women than in men (Waldréus et al., 2013; Waldréus, Chung, et al., 2018). The sensitivity of normal sensory organs and nerve reflexes decreases with age (Shi et al., 2016), which may be the main reason why young patients with HF being more likely to feel thirsty. The higher the BMI, the greater the physiological demand for water. Although the ESC guidelines for acute HF and CHF (McDonagh et al., 2021) recommend limiting fluid intake to 1.5–2.0 L/day for patients with stage D heart failure, the guidelines ignore individual BMI differences. In the future, large sample clinical studies and meta‐analyses are needed to clarify these issues.

The severity of HF is directly proportional to the severity of its symptoms, and in turn, the intensity of thirst. With the deterioration of cardiac function, the excitability of noradrenaline and sympathetic nerves in the blood increases, the cardiac output and renal blood flow decrease, and the renin–angiotensin aldosterone system is activated, leading to the increase in angiotensin II and aldosterone secretion, resulting in thirst (Ge & Xu, 2013).

Fluid restriction is the main component of non‐drug intervention for HF. Despite the lack of scientific evidence, fluid restriction is widely used in clinical practice according to the logic that limiting fluid volume can reduce the burden on the heart. It is unclear whether fluid restriction increases tHF. Therefore, it is recommended to follow the guidelines (Wang & Liang, 2018); patients with mild‐to‐moderate HF need not limit their liquid intake, whereas patients with severe HF should limit their liquid intake. We should also consider the differences between individuals. It is suggested that the daily liquid intake of patients with HF whose weight is ≤85 kg should be 30 mL/kg/day. The daily liquid intake of patients weighing >85 kg should be 35 mL/kg (Atherton et al., 2018; Holst et al., 2008).

Although several studies have reported interventions for tHF, they have not been compared due to differences in ethnicity, culture and medical settings.

Two studies reported on the effect of acupoint massage (Shuiquan point) on tHF. Lao et al. (2020) discussed the intervention effect of acupressure (Shuiquan point) alone, whereas Pan et al. (2022) studied the intervention effect of acupressure (Shuiquan point) combined with Ginseng plum decoction. Therefore, Lao et al.'s (2020) research made up for Pan et al.'s (2022) in design. However, the two studies differed in the intervention time (3 days vs. 1 month) and control group measures (moistening mouth with water‐soaked cotton swab vs. gargling with warm water). Nevertheless, based on the theory of traditional Chinese medicine that acupoint massage can dredge meridians and collaterals, regulate qi, invigorate spleen and stomach and regulate liver, gallbladder, spleen and stomach qi (Pan et al., 2022), and the theory that massaging the Shuiquan point can act on some receptors of the digestive organs, excite afferent nerves, release acetylcholine in the sublingual, parotid and submandibular glands, and increase salivary secretion (Li, Xing, et al., 2015), we have reason to believe that acupoint massage may provide thirst relief to patients with HF.

Two studies reported on the effect of ear‐point pressing beans on tHF. Wang and Zhou (2019) discussed the intervention effect of ear‐point pressing beans assisted with ginseng plum decoction, while Hou et al. (2021) studied the intervention effect of ear‐point pressing beans assisted with sugarless mint‐flavoured gum. However, neither of the two studies independently discussed the intervention effect of ear‐point pressing beans on tHF. The duration of intervention (4 weeks vs. 2 weeks) and evaluation indicators (resting state salivary flow rate and efficacy vs. the Thirst Pain Scale and Thirst Visual Analog Scale scores for patients with HF) were different.

Two studies reported on the effect of chewing gum on tHF. Allida et al. (2020) explored the intervention effect of chewing gum alone, whereas Hou et al. (2021) explored the intervention effect of chewing gum combined with ear‐point pressing beans. Allida et al. (2020) only evaluated one aspect of thirst (thirst intensity), whereas Hou et al. (2021) evaluated two aspects of thirst (thirst intensity and obsession). In addition, the study results of Allida et al. (2020) showed that there was no influence on thirst on the 4th day of intervention, and the symptoms of thirst were gradually improved on the 7th, 14th and 28th days of intervention. The principle is that chewing gum can increase the flow of saliva and promote the secretion of saliva, thus relieving thirst (Hou et al., 2021).

One study reported on eating frozen strawberries to relieve tHF. Low temperature stimulates the oropharyngeal receptors and affects vasopressin secretion (Sacrias et al., 2016); also, the sour taste of strawberries stimulates salivary glands to secrete a lot of saliva (Brunstrom & Macrae, 1997). In one study (Bai, 2022), lemonade spray alleviated tHF. Lemon is rich in citric acid, which can increase salivary secretion by stimulating parasympathetic nerves and salivary glands (Yang et al., 2015). In addition, the main components of ginseng plum decoction and black plum soup are plums. Modern pharmacological studies show that plums rich in organic acids such as malic acid and citric acid, which can stimulate the secretion of salivary glands to quench thirst (Zhang et al., 2017). Finally, the improved five‐juice drink is composed of pear juice, fresh lily juice, fresh lotus root juice, fresh reed root juice and ophiopogon on japonicus. The five flavours are sweet and cold in nature, and all have the function of clearing heat and promoting fluid production (Xi et al., 2022).

One study (Robb, 2016) reported that the use of both saliva substitute (Xialine) and sugar‐free gum significantly reduced tHF, but that, overall, patients preferred chewing gum. The reason for this is that chewing gum provides stimulation in several ways, including aroma, flavour, taste and mastication, which can increase saliva flow in a limited time (Jagodzinska et al., 2011). Xialine is a specific brand of saliva substitute that provides a coating on the oral mucosa to help retain moisture (Robb, 2016). However, a large number of studies have shown that more patients prefer chewing gum to artificial saliva (Bots et al., 2005; Davies, 2000; Jagodzinska et al., 2011).

Although the research showed that the above measures can alleviate tHF, the number is small, and a large number of clinical studies with a scientific design are needed in the future to further confirm the aforementioned findings. In addition, various measures have their own advantages and limitations. Acupoint massage and ear‐point pressing bean therapy are characteristic therapies in Chinese medicine, which are mainly used in China at present. Although these two methods are simple and easy to perform with a high degree of safety, the implementer needs to master certain theoretical knowledge of Chinese medicine; moreover, some patients may be allergic to adhesive tape (Pan et al., 2022; Wang & Zhou, 2019). The method of chewing gum is simple and low‐cost. However, most patients with HF are older adults, and most have false teeth. As such, they have low compliance with the use of chewing gum. (Allida et al., 2020). Furthermore, frozen strawberries tend to be too cold, and some older patients are unwilling to choose this method of relieving thirst. Although the ingredients of ginseng plum decoction, black plum soup and improved five‐juice drink are safe and taste good, they enter the patient's body in the form of a spray or liquid. As such, long‐term use will increase the liquid intake, and the preparation of these liquids may be troublesome, since the proportion and preparation time of these concoctions need to be mastered. Therefore, patients with HF and thirst can choose their own methods according to the existing measures and can also further explore the strategies recommended by experts. Safety, effectiveness, simplicity and practicality have always been the main principles of measures to alleviate tHF. Finally, although the specific intake control scheme is controversial, fluid restriction is still the universal treatment scheme for patients with tHF (Li, Fu, & Qian, 2015).

6.1. Limitations of this review

This scoping review summarised the thirst‐related knowledge regarding patients with HF. This review is more systematic and comprehensive than previous similar studies and can be used as the basis for future research on thirst interventions in patients with HF. However, it has the following limitations. First, only Chinese and English articles were included in the study, excluding those published in all other languages; this selection may have led to the incomplete inclusion of relevant information. Second, following the theoretical framework of Arksey and O'Malley, the reviewed research quality has not been formally assessed; therefore, our research results should be further confirmed. Furthermore, although the included studies came from many different countries, most were from China and Sweden, restricting the applicability of the research results. Therefore, further research is needed in an international context to form a consensus on intervention measures for tHF. Finally, the included qualitative studies lacked original qualitative studies except for the review, which could be considered in the future.

7. CONCLUSION

This scoping review indicated that the incidence of tHF is high, which should be widely focused on by healthcare workers. Although there are many factors, including sex and age, associated with tHF, it is unclear whether men or women are more likely to be thirsty. There was also disagreement about whether young or old patients with HF were more likely to feel thirsty. In addition, there are great differences among the interventions for tHF. Although traditional Chinese therapy has shown good research potential in the treatment of tHF, its application and promotion in Western countries are limited. Artificial saliva and other measures often used to alleviate thirst in patients undergoing haemodialysis have not been tried in patients with HF and thirst. In the future, large sample and multicentre research can be carried out to find out the obstacles and promoting factors of thirst in patients with HF, and effective intervention measures can be identified and implemented to alleviate the symptoms of thirst in patients with HF and improve their quality of life.

8. RELEVANCE TO CLINICAL PRACTICE

Thirst is one of the most debilitating symptoms in patients with HF. This scoping review could help clinical workers understand the incidence and related factors of tHF systematically, so as to pay more attention to the symptoms of thirst in such patients, and provide timely targeted measures to reduce the discomfort of patients, improve their quality of life and benefit patients. At the same time, it provides a reference for future research and guidelines.

AUTHOR CONTRIBUTIONS

Each author of this study has substantially contributed to conducting the underlying research and drafting the manuscript. Yaya Chen contributed to the conceptualisation, writing—original draft and writing—review and editing. Jin Ding contributed to the project administration, writing–review and editing, and supervision. Yingbo Xi contributed to the data curation and formal analysis. Minfeng Huo contributed to the formal analysis and visualisation. Yingjian Mou contributed to the conceptualisation, review and editing, and supervision. Yu Song contributed to the investigation and data curation. Hailing Zhou contributed to the investigation and data curation. Xiaoqin Cui contributed to the visualisation, review and editing.

CONFLICT OF INTEREST STATEMENT

There are no conflicts of interest related to this article.

RESEARCH ETHICS COMMITTEE APPROVAL

As this was a scoping review, Research Ethics Committee approval was not required in this study.

Supporting information

Appendix S1

Click here for additional data file. (1.2MB, docx)

Appendix S2

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Appendix S3

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Table S1

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ACKNOWLEDGEMENTS

We would like to thank Wiley Editing Services (http://wileyeditingservices.com) for English language editing.

Chen, Y. , Ding, J. , Xi, Y. , Huo, M. , Mou, Y. , Song, Y. , Zhou, H. , & Cui, X. (2023). Thirst in heart failure: A scoping review. Nursing Open, 10, 4948–4958. 10.1002/nop2.1818

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available in the supplementary material of this article.

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Associated Data

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Supplementary Materials

Appendix S1

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Appendix S2

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Appendix S3

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Table S1

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Data Availability Statement

The data that support the findings of this study are available in the supplementary material of this article.

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