Leeds Primary Care Heart Failure Management

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1.  Information Resources for Patients and Carers

Quick info:

Patient.co.uk - Heart Failure Patient Information

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2.  Referral Forms

Quick info:

Leeds Integrated Heart Failure Service Form

NB Use this form for both 2 week and 6 week pathway

Community Heart Failure Team Form

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5.  ACE inhibitor

Quick info:

Start with ramipril 1.25mg BD Target dose is 5mg of ramipril BD

Up-titrate dose every 2 weeks until optimum tolerated or target dose achieved

Renal function and electrolytes (U+E's) at initiation and each dose increment

Use candesartan if genuine intolerance to ACE inhibitor

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6.  Beta-Blocker

Quick info:

Start with bisoprolol 1.25mg per day

Increase every 2 weeks as tolerated

Target dose is 10mg of bisoprolol per day

Check no contraindications (smoking related COPD is NOT a contraindication)

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7.  Loop diuretic

Quick info:

Use for sympton control af fluid overload

Increase or decrease dependent on symptoms

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19. Refer to Community Heart Failure if Ongoing Symptoms, Fluid Overload or Deteriorating Investigations

Quick info:
Referral Form


The community heart failure service operates city wide and forms part of the Leeds Cardiac Service. It aims to improve the quality of life for patients diagnosed with heart failure and reduce the need for repeat admission to hospital. The service comprises a team of cardiac nurse specialists along with administrative support.

What does the Service offer

  • Support and advice to the patient following a diagnosis of heart failure
  • Education about heart failure and self-management of the condition
  • Medication concordance education
  • Working alongside medical staff to ensure treatment is optimised and symptoms are controlled
  • Close monitoring of haemodynamic status and early detection of deterioration of condition
  • Working with the multi-disciplinary team to ensure effective management of this chronic disease patient group
  • Adherence to evidence-based best practice guidelines in accordance with NICE, SIGN and the NSF

How is the Service delivered

  • The cardiac nurse specialists provide a link between secondary care and primary healthcare teams e.g. GP’s, practice nurses, community matrons, district nurses, intermediate care team and social services
  • Patients who have been accepted by the service will receive visits either in the patient’s home or at a local health clinic and be given access to a telephone advice line

Referral Criteria

Referrals will be accepted for patients with a confirmed diagnosis of Left Ventricular Systolic Dysfunction (LVSD) who are/have in addition:

  • Complex/unstable presentation
  • Palliative care requirements/symptom control
  • Compliance/concordance issues
  • Diuretic resistance
  • Post device therapy
  • Complex titration requirements in the presence of polypharmacy
  • Vulnerable or ‘hard to reach’ (e.g. access/language difficulties)
  • Assistance needed with self management

Exclusion criteria

  • Patients with end stage terminal illness other than heart failure
  • Severe uncontrolled mental illness
  • Unwilling to accept treatment
  • HF with preserved ejection fraction

Referrals will be accepted from:

  • The rapid access heart failure service at LTHT
  • Cardiology wards/Cardiac Liaison team - LTHT
  • Outlying acute trusts/Heart Failure Specialist Nurses (e.g. Bradford, Harrogate etc)
  • GPs
  • Other HCPs (e.g. community matrons)
  • Self referral from previous patients
  • Primary Care Access Line (PCAL) for IV diuretic service only

Discharge Criteria

Patients are discharged to primary care with a management plan when:

  • NYHA 1
  • Stable NYHA II-III
  • Able to self manage symptoms
  • Unwilling to participate in any aspect of management plan

Patients who may require input from the Leeds Integrated Heart Failure Service will be referred back or advice will be sought by telephone.

How to Refer to the Service

GP’s and other health professionals such as practice nurse, community matrons and district nurses may refer suitable patients.

The referral form should be completed and faxed to the Community Cardiac Team on (0113) 843 4201. To discuss a referral or any aspect of the service, please telephone our central referral point on Tel: (0113) 843 4200

Key Dates

Published: 15-Mar-2013, by Leeds
Valid until: 01-Oct-2016


This is a list of all the references that have passed critical appraisal for use in the care map Heart failure

ID  Reference

1   National Institute for Health and Clinical Excellence (NICE). Chronic heart failure - National clinical guideline for diagnosis and management in primary and secondary care. Clinical Guideline No 108. London: NICE; 2010. http://www.nice.org.uk/nicemedia/live/13099/50514/50514.pdf

2   Clinical Knowledge Summaries. Heart failure - chronic. Version 1.0. Newcastle upon Tyne: CKS; 2009.

3   Scottish Intercollegiate Guidelines Network (SIGN). Management of chronic heart failure. Publication no 95. Edinburgh: SIGN; 2007. http://www.sign.ac.uk/pdf/sign95.pdf

4   Map of Medicine (MoM) Clinical Editorial team and Fellows. London: MoM; 2011.

5   European Society of Cardiology (ESC). ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008. Eur Heart J 2008; 29: 2388-2442. http://eurheartj.oxfordjournals.org/content/29/19/2388.full.pdf+html

6   Driver and Vehicle Licensing Agency (DVLA). At a glance guide to the current medical standards of fitness to drive. Swansea: DVLA; 2010. http://www.dft.gov.uk/dvla/~/media/pdf/medical/at_a_glance.ashx

7   National Institute for Health and Clinical Excellence (NICE). Cardiac resynchronisation therapy for the treatment of heart failure. Technology appraisal 120. London: NICE; 2011. http://www.nice.org.uk/nicemedia/pdf/TA120Guidance.pdf

8   National Institute for Health and Clinical Excellence (NICE). Implantable cardioverter defibrillators (ICDs) for the treatment of arrhythmias (review of TA11). Technology appraisal 95. London: NICE; 2006. http://www.nice.org.uk/nicemedia/live/11566/33167/33167.pdf

9   National Institute for Health and Clinical Excellence (NICE). Short-term circulatory support with left ventricular assist devices as a bridge to cardiac transplantation or recovery. Interventional procedure guidance 177. London: NICE; 2006. http://guidance.nice.org.uk/nicemedia/live/11049/30742/30742.pdf

10 National Institute for Health and Clinical Excellence (NICE). Venous thromboembolism: reducing the risk of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in patients admitted to hospital. Clinical guideline 92. London: NICE; 2010. http://www.nice.org.uk/nicemedia/live/12695/47195/47195.pdf

11 The task force on myocardial revascularization of the European Society of Cardiology (ESC) and the European Association for Cario-Thoracic Surgery (EACTS). Guidelines on myocardial revascularization. Eur Heart J 2010; 31: 2501-2555. http://www.escardio.org/guidelines-surveys/esc-guidelines/GuidelinesDocuments/guidelines-revasc-FT.pdf

12 McKelvie RS. Heart Failure. London: Clin Evid; 2011. http://www.ncbi.nlm.nih.gov/pubmed/21878135

13 van der Meer S, Zwerink M, van Brussel M et al. Effect of outpatient exercise training programmes in patients with chronic heart failure: a systematic review. Eur J Cardiovasc Prev Rehabil 2011; [Epub ahead of print]: http://www.marcovanbrussel.com/publicaties/48.pdf

14 Kuenzli A, Bucher HC, Anand I et al. Meta-analysis of combined therapy with angiotensin receptor antagonists versus ACE inhibitors alone in patients with heart failure. PLoS One 2010; 5: e9946. http://www.ncbi.nlm.nih.gov/pubmed/20376345

15 Adabag S, Roukoz H, Anand IS et al. Cardiac resynchronization therapy in patients with minimal heart failure: a systematic review and meta-analysis. J Am Coll Cardiol 2011; 58: 935-41. http://www.ncbi.nlm.nih.gov/pubmed/21851882

16 Swedberg K, Komajda M, Bohm M et al. Ivabradine and outcomes in chronic heart failure (SHIFT): a randomised placebo-controlled study. Lancet 2010; 376: 875-85. http://www.ncbi.nlm.nih.gov/pubmed/20801500

17 Lambrinou E, Kalogirou F, Lamnisos D et al. Effectiveness of heart failure management programmes with nurse-led discharge planning in reducing re-admissions: A systematic review and meta-analysis. Int J Nurs Stud 2011; 49: 610-24. http://www.ncbi.nlm.nih.gov/pubmed?term=22277180%20

18 Lowery J, Hopp F, Subramanian U et al. Evaluation of a nurse practitioner disease management model for chronic heart failure: a multi-site implementation study. Congest Heart Fail 2012; 18: 64-71. http://www.ncbi.nlm.nih.gov/pubmed?term=22277180%20

19 Bleeker GB, Holman ER, Steendijk P et al. Cardiac resynchronization therapy in patients with a narrow QRS complex. J Am Coll Cardiol 2006; 48: 2243-50. http://www.ncbi.nlm.nih.gov/pubmed/17161254

20 Van Bommel RJ, Gorcsan J III, Chung ES et al. Effects of cardiac resynchronisation therapy in patients with heart failure having a narrow QRS Complex enrolled in PROSPECT. Heart 2010; 96: 1107-13. http://www.ncbi.nlm.nih.gov/pubmed/20610457

21 Foley PW, Patel K, Irwin N et al. Cardiac resynchronisation therapy in patients with heart failure and a normal QRS duration: the RESPOND study. Heart 2011; 97: 1041-7. http://www.ncbi.nlm.nih.gov/pubmed/21339317

22 Contributors representing the Royal College of Physicians;. London: 2012.

23 Higgins J, Lamarche Y, Kaan A et al. Microaxial devices for ventricular failure: a multi-centre, population- based experience. Can J Cardiol 2011; 27: 725-30. http://www.ncbi.nlm.nih.gov/pubmed/21983112

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