Editor,—Stromberg’s recent editorial highlighted the increasing prevalence of congestive cardiac failure (CCF) in the Western world and made the point that the cost of frequent hospital admissions with decompensated CCF consumes a large and growing proportion of health service budgets.1 Several studies have demonstrated the effectiveness of various complex interventions in reducing the number of admissions with decompensated CCF compared to usual care—for example, through the use of nurse practitioners specialising in heart failure and dedicated heart failure clinics.2-4 As well as reducing the morbidity associated with CCF—an important goal in itself—such interventions have the potential to reduce total costs, but only where the cost of the intervention is less than the saving produced. At least one study in the …