Proposed model for a hospital based heart failure service
| Identification of high risk patients in the community |
| • Coronary heart disease registry (angina, previous myocardial infarction, coronary artery bypass graft) |
| • Patients with abnormal ECG particularly with Q waves, left ventricular hypertrophy, and atrial fibrillation |
| • Patients with diabetes and hypertension |
| Screening |
| • 12 lead ECG |
| • Chest radiograph if available |
| • Possibly brain natriuretic peptide |
| Heart failure service |
| • Diagnostic service (technician led, five patients in a session, up to five sessions a week |
| • Heart failure treatment optimisation service (physician led, heart failure specialist nurse), 7–10 patients a session, two to three clinics a week) |
| Follow up |
| • General practitioners |
| • Possibly general practitioner cardiologists |
| • Heart failure specialist nurses |
| • Treatment optimisation clinic |