Even the widely embraced dictum of sodium restriction in HF is not well supported by current evidence. Moreover, the majority ofthe clinical trials that inform GDMT were designed around the primary endpoint of mortality, so that there is less certainty about the impact of therapies on the health-related quality of life of patients. It is also ofmajorconcernthatthemajorityofrandomizedcontrolledtrials failed to randomize a suf cient number of the elderly, women, and underrepresented minorities, thus limiting our insight into these important patient cohorts. A growing body of studies on patient-centered outcomes research is likely to address some of these de ciencies, but time will be required. HF is a syndrome with a high prevalence of comorbidities and multiple chronic conditions, but most guidelines are developed for patients with a single disease. Nevertheless, the coexistence of additional diseases such as arthritis, renal Table 25. 