Quality of the clinical evidence No clinical evidence was identified for inclusion within the review. Chronic Heart Failure Domiciliary oxygen therapy in people with advanced heart failure NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: 978-1-4731-3093-7 Recommendations No recommendation Research recommendation In people with advanced heart failure and significant peripheral fluid overload, what is the clinical and cost effectiveness of oral, subcutaneous and intravenous diuretic therapy in the community? Trade-off between clinical benefits and harms As no randomised controlled studies were found that addressed the review question, the committee was not able to make a recommendation on the clinical effectiveness of IV and oral diuretics delivered in the community. The committee decided to make a research recommendation to establish the added value of IV or subcutaneous diuretics (in terms of its clinical and cost effectiveness) in the management of advanced heart failure, for the reasons discussed below. Trade-off between net clinical effects and costs No previously published economic evaluations were identified. Unit costs were not presented for this review due to the lack of clinical evidence available for the committee to make a judgement of cost effectiveness of the routes of administration of diuretics. However, the committee noted that delivering diuretics subcutaneously and intravenously would incur a higher cost to the NHS compared to administering oral diuretics due to the additional equipment and staff costs of delivery The committee agreed that due to the greater cost of subcutaneous and IV diuretics therapy compared to oral diuretics, it was important that an assessment of the cost effectiveness of these different administration routes was included in the research recommendation. Other considerations The committee considered the use of IV and subcutaneous diuretics in people with advanced chronic heart failure to be an area of high priority for future research. 