# Facilitators and barriers to volume management interventions in patients with heart failure and hyponatremia: a qualitative study

## TL;DR

This study explores what helps and hinders managing fluid levels in heart failure patients with low sodium, using interviews with healthcare professionals, patients, and caregivers.

## Contribution

The study identifies specific facilitators and barriers to implementing hyponatremia-sensitive volume management in heart failure patients.

## Key findings

- Tailored strategies and workflow alignment are key facilitators for effective volume management.
- Limited evidence access and poor care transitions are major barriers to implementation.
- Awareness without capability and geriatric constraints hinder sustained practice.

## Abstract

Heart failure is highly prevalent among older adults, and volume management is central to both medical treatment and nursing care. Patients with concomitant hyponatremia often require tailored, hyponatremia-sensitive strategies; however, such personalized approaches are variably implemented in routine practice.

Qualitative interviews guided by the Consolidated Framework for Implementation Research (CFIR 2.0) were conducted with 12 healthcare professionals, 10 patients with heart failure and hyponatremia, and 10 caregivers. Data collection continued until data saturation was reached, defined as no new themes emerging in three consecutive interviews. Data were analyzed using thematic analysis.

We identified three facilitator themes: (1) tailored targets and support that make volume management workable; (2) alignment of individualized targets with existing heart failure workflows; and (3) hyponatremia awareness and belief in the value of implementation. We also identified four barrier themes: (1) limited access to trusted, actionable evidence that undermines hyponatremia-sensitive volume management; (2) gaps in discharge preparation and care transitions that disrupt continuity across care settings; (3) awareness alone, without sufficient capability, that limits practical execution; and (4) geriatric constraints and limited support capacity that hinder sustained implementation.

By synthesizing the identified facilitators and barriers, we found that volume management for patients with heart failure and hyponatremia represents a more individualized, dynamic, and precise approach than routine volume management. The barriers helped clarify current gaps in hyponatremia-sensitive volume management and informed multi-level strategies to address them. These findings provide a theoretical foundation for optimizing volume management in patients with heart failure complicated by hyponatremia in clinical practice.

The trial was registered at the Chinese Clinical Trial Registry under the identifier ChiCTR2400089084 on September 2, 2024.

The online version contains supplementary material available at 10.1186/s12877-026-07080-y.