Unlearning outdated practices: Using the evidence to deliver better patient care

Recently, while attending the EuroHeartCare conference in Milan, Italy (May 2-4, 2019), I was very impressed by a poster from my colleagues van der Wal and Jaarsma.1 The poster presented a survey of 168 nurses in the Netherlands who cared for patients with heart failure (HF) and asked about the practice of fluid and sodium restriction.1 Although a widespread and well-established practice, there is little evidence for fluid and sodium restriction in patients with stable HF. Recent guidelines (2016) from the European Society of Cardiology recommend that patients with HF should avoid excessive fluid and salt intake, but that fluid restriction of 1500–2000 mL per day should be considered only in patients with severe HF to relieve symptoms and congestion.2