Do you still recommend a low-sodium diet in a patient with heart failure given recent data and guideline changes supporting more liberal intake?

Thanks for the question. It is a difficult one, and there remains a lot of variability regarding sodium intake and HF management. There are a few trials and conflicting results. There is also significant variability amongst individual patients. For example, those patients requiring no or small loop diuretic dosing tend not to require sodium restriction. Generally speaking, however, we will still use some restriction (3,000 mg) in those with larger diuretic requirements and/or recent hospitalizations for ADHF manifest as congestion. As you state, we no longer advocate for severe dietary sodium restriction. Trials have not shown a benefit in hospitalized patients. These severe restrictions increase neurohormonal response in those who often ar...