{
  "abstract": "The paradigm shifts in heart failure (HF) treatment strategies have been accompanied by changes in the understanding and definition of the condition.1 The ancient Greek physician Hippocrates had already described conditions of ‘dyspnea’ and ‘dropsy’. Yet he saw them not as disorders of the heart but as the consequence of a disturbance in the balance of the humours, and sought remedies through phlebotomy and fluid expulsion. With advances in pathophysiology, HF was defined in the early 20th century as ‘a state in which the heart cannot adequately eject its contents’. For decades thereafter, treatments focused on cardiac stimulants and diuretics. In the 1980s, HF came to be recognised as a ‘syndrome’ involving neuroendocrine factors such as the sympathetic nervous system (SNS) and the renin-angiotensin-aldosterone system (RAAS), bringing about a dramatic transformation in its treatment. Specifically, the focus shifted from traditional symptomatic therapies centred on diuretics and cardiac stimulants to disease-modifying approaches targeting these neurohumoral pathways, most notably with beta-blockers and ACE inhibitors. At present, HF is defined as ‘a clinical syndrome with signs and/or symptoms caused by structural and/or functional cardiac abnormalities, corroborated by elevated levels of B-type natriuretic peptide (BNP) or N-terminal proBNP (NT-proBNP), and/or objective evidence of pulmonary and systemic congestion’.2 Over recent decades, both pharmacological therapies—including sodium-glucose cotransporter 2 inhibitors, angiotensin receptor-neprilysin inhibitors and glucagon-like peptide-1 receptor agonists—and non-pharmacological approaches such as cardiac resynchronisation therapy and rhythm restoration have advanced considerably, with survival showing an encouraging overall trend. Nevertheless, more than 60 million people are affected worldwide, and the prevalence continues to rise in the context of a rapidly ageing population. Coupled with the non-negligible costs of novel therapies, the societal and economic burden remains substantial. This underscores the need for more accessible and cost-effective strategies for HF management.",
  "authors": [
    {
      "affiliations": [
        "Department of Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany",
        "DZHK (German Centre for Cardiovascular Research), partner site Lower Saxony, Lower Saxony, Germany"
      ],
      "name": "Ryosuke Sato"
    },
    {
      "affiliations": [
        "Department of Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany",
        "DZHK (German Centre for Cardiovascular Research), partner site Lower Saxony, Lower Saxony, Germany"
      ],
      "name": "Constanze Schmidt"
    },
    {
      "affiliations": [
        "Department of Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany",
        "DZHK (German Centre for Cardiovascular Research), partner site Lower Saxony, Lower Saxony, Germany"
      ],
      "name": "Stephan von Haehling"
    }
  ],
  "title": "Heart failure and fluid restriction: time to let go?",
  "uid": "728abf6b-b89c-56e9-bdeb-c8257ce73983"
}