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.
For many people living with heart failure, thirst is an everyday struggle that is often overlooked by doctors and researchers. Nearly 7 out of 10 patients report feeling moderate to severe thirst, especially when their condition is advanced or when they are asked to limit how much fluid they drink. This constant thirst can be exhausting, leading to stress, loneliness, and a poorer quality of life.
This review looked at recent studies on why thirst happens in heart failure, what it means for patients, and how it can be managed. Severe thirst has been linked to difficulties in following fluid restrictions, greater emotional distress, and even a higher chance of returning to the hospital within six months. Supportive strategies like patient education, regular follow-ups, and certain medications such as tolvaptan may help ease this burden.
Despite its impact, thirst is rarely studied in heart failure, and more attention is urgently needed.