Thirst in heart failure: a neglected symptom with profound implications for patient management and quality of life

Thirst is a common yet underrecognized symptom in patients with heart failure (HF), exerting a significant impact on disease management, treatment adherence, and quality of life (QoL). Approximately 65-75% of patients with HF report moderate to severe thirst, particularly in advanced stages of the disease or under strict fluid restrictions contributing to psychological distress, social isolation, and diminished well-being.

This systematic review explores the pathophysiology, clinical consequences, and management of thirst in HF. A literature search of PubMed, Embase, Scopus, and Web of Science (2015-2025) identified studies addressing thirst prevalence, neurohormonal and electrolyte mechanisms, and therapeutic interventions. Severe thirst has been associated with poor adherence to fluid restriction, increased psychological distress, and a 40% higher risk of hospital readmission within six months of discharge. Patient-centered strategies, such as structured education and follow-up programs, have been shown to improve adherence and reduce thirst burden.

Despite its clinical importance, thirst remains underaddressed in HF care, with fewer than 20% of studies evaluating it as an outcome. The development of standardized assessment tools, implementation of long-term intervention studies, and incorporation of thirst management into routine HF care are essential steps toward improving patient outcomes and QoL.