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. Other considerations The committee are aware of a recently published large observational study104 (with propensity matching on plausible confounders) on the impact of dietary sodium restriction on heart failure outcomes. The study included patients in an unrelated trial, categorising them into sodium restricted and unrestricted groups based on their sodium intake prior to death or hospitalisation. This study found that sodium restriction was associated with a statistically significant and clinically important increase in the risk of death or HF hospitalisation, and was not associated with improved quality of life, physical functioning, 6-min walk distance, or symptoms. The study concluded that in symptomatic patients with chronic HF, sodium restriction may have a detrimental impact on outcome . While a randomised trial is needed to definitely address the role of sodium restriction in heart failure, the 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. 