Heart failure management in the community to prevent admission or readmission, patient reviews within two weeks post-discharge, a mix of clinics, home visits, and telephone consultations, medication titration to maximize doses, support with end-of-life care, patient education for self-management, and referrals back to the GP for routine care once stabilized.

Eligibility Criteria

Inclusions

• aged 18+ and registered with a GP in Islington or Haringey
• Confirmed diagnosis of heart failure with HFrEF and HFpEF; the diagnosis must be confirmed by an echocardiogram and the patient must have been seen by a cardiologist or a physician with a specialist interest in heart failure in line with NICE guidelines (this information must be provided on referral to the CHFNS). The CHFNS will accept patients with heart failure with normal left ventricular ejection fraction (HFpEF) with a clear management plan completed by the named cardiologist on referral and with the following criteria only:
  • normal left ventricular ejection fraction (LVEF 50% or more on echocardiography) with moderate or severe left ventricular diastolic dysfunction and dilated left atrium (LAVI >38 ml/m2) and/or left ventricular hypertrophy (indexed LV mass >110 g/m2 for men and >99 g/m2 for women), or
  • normal left ventricular ejection fraction (LVEF 50% or more on echocardiography) with severe valvular dysfunction.
• newly diagnosed or unstable confirmed heart failure commencing on/or support with medication/treatment optimisation
• patients requiring specialist education, advice, information and support at any stage in their disease pathway from diagnosis through to palliative care stages
• end-stage heart failure.

Exclusions

• Patients aged under 18
• Echo not available (all referrals without an available echo will be appropriately signposted and followed up with GP or cardiology team as required)
• Acute myocardial infarction within six weeks of referral with subsequent heart failure
• Patients requiring hospital transfer for cardiology intervention
• Patients who refuse to receive care from the team 
• Pregnant patients
• Patients with significant valvular disease awaiting valve surgery (AVR/MVR)
• Patients echoed in atrial arrhythmias with heart rate exceeding 100bpm require rate control and re-echo before referral
• Patients with COPD and Cor pulmonale (advice may be offered to respiratory team for management of diuretics)
• Normal LVEF with primarily pulmonary hypertension (under care of pulmonary hypertension team at RFH Trust)
• Normal LV function with end-stage renal disease CKD 4 0r 5 with eGFR ≤ 15/ patients on dialysis
• HFpEF patients that are not on a medium-dose loop diuretic (80mg Furosemide or Bumetanide equivalent) and with no recent HF admission
• HFPEF with no management plan from cardiologist
• Patients registered with a GP outside NCL
• Other immediately life-threatening illness, for example, advanced malignancy
• Aggressive/abusive behaviour
• Non adherence with mental capacity
• DNA two consecutive appointments or cancel two in under 24 hours consecutively
• CKD IV at discretion of cardiologist and renal team (eGFR15-30)
• Stable symptoms and medications optimised. 

How to Refer