Continue to review the need to restrict salt or fluid. [2018] Advise people with heart failure to avoid salt substitutes that contain committee considered that this non-randomised evidence provided further support for its recommendation to not routinely offer sodium restriction until such randomised evidence is available. Current practice regarding salt and fluid restriction is highly variable, with some healthcare professionals advising patients to restrict intake and others not. The lay members indicated that salt and fluid restriction is the subject of much discussion in patient groups. Given it is one of a limited number of opportunities for self-management in HF, some patients may feel that it enables them to exercise some personal control over the course of what is an unpredictable and serious long term condition. However, the variation in practice and advice has led to confusion and uncertainty among patients about whether salt and fluid restriction is necessary or beneficial. The recommendation to not routinely advise salt and fluid restriction should operate to reduce variation in practice across the country, and ensure that any discussions between patients and healthcare professionals start from a consistent position. Where patients are currently attempting to restrict salt and/or fluid without specific clinical circumstances for doing so, healthcare professionals should discuss the uncertainty in the evidence with those patients as part of shared decision making. Patients may have been asked to restrict fluid intake during acute episodes, and not given information on when this is no longer indicated. The decision on whether to continue to restrict salt and/or fluid should take into account patient preferences. Chronic Heart Failure Beta-blockers in heart failure and concomitant atrial fibrillation NICE 2018. All rights reserved. Subject to Notice of rights. 