The committee also discussed the evidence for a fluid restriction programme compared with general advice to restrict fluid, which again was based on a single small trial. The fluid restriction programme did appear to have a clinically important impact on actual levels of fluid consumed in each group, with the general advice group consuming 300mL more per day on average than the restriction programme group. Quality of life was lower in the restriction programme group than in the general advice group which was agreed to represent a clinically important reduction. The restriction programme did not appear to have any impact on oedema measured via a congestion score , though the committee placed little weight on this scale that has not been validated. In weighing up the possible benefits and harms of salt and fluid restriction, the committee acknowledged the quality of the evidence, which ranged from low to very low, and the uncertainty around the effect estimates. The absence of evidence on most of the outcomes was noted, in particular Chronic Heart Failure Beta-blockers in heart failure and concomitant atrial fibrillation NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: 978-1-4731-3093-7 Recommendations Do not routinely advise people with heart failure to restrict their sodium or fluid consumption. Ask about salt and fluid consumption and, if needed, advise as follows: restricting fluids for people with dilutional hyponatraemia reducing intake for people with high levels of salt and/or fluid consumption. Continue to review the need to restrict salt or fluid. [2018] Advise people with heart failure to avoid salt substitutes that contain hospitalisation, which was stated to be critical for decision making. 