In particular, the large RCT currently underway comparing a low sodium diet versus usual care (general advice to limit salt) (SODIUM-HF346 ). Given the importance of this issue to patients, the potential for significant negative impact on quality of life, and the absence of any randomised evidence of benefit, a do not routinely offer recommendation was made, acknowledging that this review will be updated in the future if new evidence arises to change the recommendation. The need for further trials of fluid restriction was considered either of advice about restriction, or based on actual restriction values While some further guidance on overall efficacy would clarify the population benefit, further research would be difficult to carry out, and would not change the conclusion that advice should be given on an individual basis according to intake and fluid balance in the individual. Trade-off between net clinical effects and costs No previously published economic evaluations were identified assessing the cost effectiveness of salt and/or fluid restriction programmes in people with heart failure. As described in the trade of between clinical benefits and harms above, the committee considered that the harms of salt and fluid restriction, particularly in terms of quality of life, outweighed the benefits in most circumstances, and therefore decided that salt and fluid restriction should not be routinely offered. Current practice is highly variable, but many health professionals do advise people with heart failure to restrict their salt and fluid intake. The committee therefore considered that implementing a do not routinely offer recommendation might improve quality of life for current heart failure patients and could also be cost saving due to reduced appointment time as most people will no longer require information and advice on how to restrict their intake of salt and fluid. 