Chronic heart failure (HF) is a major public health and social problem. Its prevalence increases with age to reach approximately 10% after 70 years 1,2. This high prevalence is expected to evolve further as a result of the continuous aging of the population, improved survival of patients with different heart diseases and effective treatments for HF. Despite the significant progress in the
diagnosis and treatment of HF, this condition remains a major cause of morbidity and mortality with
a 5-year mortality rate of ~50% after first onset of symptoms 3. Management of HF includes both
pharmacological and non-pharmacological interventions. Among non-pharmacological interventions, dietary sodium restriction is commonly recommended and is endorsed by most
international guidelines 4,5. However, these recommendations are based on limited evidence with
inconsistent findings across studies 6. Furthermore, available data suggest that less than half of HF
patients actually follow these recommendations 7 rising questions about compliance and the
underlying reasons of non-compliance.
Compliance to diet is closely related to patient subjective perceptions and expectations. In this
regard, chronic heart failure is a complex condition that requires important personal investment from
patients to manage their disease. However, the alteration in their long-standing personal habits and
life style may lead to perceive the dietary sodium restriction diet as a negative intervention 8.
Indeed, many patients with HF may face a variety of constraints due to this regimen that cover social,
emotional, organizational and economic aspects of daily life, all limitations that can be captured by
the notion of “burden”.
Current existing scales for evaluating quality of life in patients with HF are fundamentally
limited for assessing this burden, since they include few to none items inquiring patients about their
diet, whether they be generic like the SF-36 9, disease-specific like the Minnesota living with heart
failure questionnaire 10, or diet-targeted but focused on conditions too specific to be generalizable
to other contexts 11,12.
To the best of our knowledge, there is no tool available for evaluating the burden experienced
by patients with heart failure on low-sodium diet and so there is a pressing need for accurate tools to
measure this burden. Thus, developing a dedicated instrument would be beneficial to ascertain HF
patients’ concerns and their physicians alike for identifying which patients are in need of more
sustained monitoring or support for their diet. The objective of the present study was therefore to
develop and validate a new scale, the “Burden scale In Restricted Diets” (BIRD) to allow an adequate
evaluation of the burden associated with dietary sodium restriction in heart failure patients.


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