[2018] Advise people with heart failure to avoid salt substitutes that contain hospitalisation, which was stated to be critical for decision making. Although there was only limited evidence and it was uncertain, the committee felt that the the possible negative impact of salt and fluid restriction programmes on patient experience and quality of life should not be ignored. Committee members agreed that the negative impact on quality of life was consistent with their experience in practice, particularly with older, frailer HF patients who often do not drink sufficient fluid, so any advice to restrict fluid further may risk serious dehydration in some patients. In the absence of any evidence of benefit, the committee decided that patients should not be routinely advised to restrict their salt and fluid consumption. The committee discussed whether it would be beneficial to cross-refer to existing healthy eating, cardiovascular risk management or hypertension NICE guidance in the recommendation, but agreed some of this guidance may, in fact, be dangerous to HF patients (for example, the use of sodium substitutes that contain potassium would put HF patients at higher risk of hyperkalaemia). The change in recommendations in standard drug treatments, will result in triple therapy with ACE inhibiter, beta-blocker and MRA becoming more common, and the risks of hyperkalaemia are significant if people are advised to switch from salt to potassium-containing salt substitutes (particularly if their baseline levels of salt intake are high, leading to high level of substitute consumption). A consensus recommendation was made that they should be avoided in the heart failure population, in the hope that this would facilitate communication between patients and professionals on this point. While healthcare professionals should not routinely advise patients to restrict salt or fluid, there may be specific clinical circumstances where restriction is appropriate. 