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Systems of care for heart failure: bridging the divide between primary care and specialist services
  1. Geraint Morton1,
  2. Jim Moore2
  1. 1 Cardiology, Portsmouth Hospitals NHS Trust, Portsmouth, UK
  2. 2 Gloucestershire Heart Failure Service, Gloucestershire Health and Care NHS Foundation Trust, Gloucester, UK
  1. Correspondence to Dr Geraint Morton, Cardiology, Portsmouth Hospitals NHS Trust, Portsmouth PO6 3LY, UK; geraintmorton{at}

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Learning objectives

  • To understand that optimal heart failure (HF) care requires a multidisciplinary team which includes generalists and specialists and spans both community and hospital settings.

  • To understand that designing a system of care to support seamless working between primary care and specialist services is crucial for optimal HF care.

  • To understand that there are many models of how these systems of care can work, the evidence base behind various components and the many areas where pathways can, and should, be improved.


Heart failure (HF) is common, affecting millions of people globally.1 For most patients it is a chronic illness which causes a very heavy humanistic2 and financial burden.3 The last few decades have brought many notable successes for treating HF, resulting in significant incremental improvements in symptoms and reductions in hospital admissions and mortality. Therapies tailored to individual patients result in very large population level benefits.

Patients with HF have multiple and varied care requirements, which change during the course of their illness, and necessitate repeated transition between primary and specialist care. Specialist multidisciplinary teams (MDT) spanning community and hospital care systems are required to deliver optimal HF care. Patients need rapid access to these teams repeatedly and unpredictably. However, systems of care are complex and difficult to test and compare, making it hard to demonstrate their value. Establishing MDTs and providing good systems of care is expensive and time consuming and therefore frequently neglected in busy, financially constrained and short-term focused settings. We explore the interface between primary and specialist systems of care for HF and how ensuring this works well is crucial to achieving the best possible outcomes. Healthcare systems vary between and within countries and there is self-evidently no ‘one size fits all’ but the general principles will apply in most healthcare settings.

HF diagnosis

Identifying patients in the community

Early diagnosis …

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  • Contributors GM drafted and revised the manuscript. JBM critically appraised and revised the important content within the manuscript. Both authors read and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests GM is on the editorial board for BMJ Heart.

  • Provenance and peer review Commissioned; internally peer reviewed.

  • Author note References which include a * are considered to be key references.