Introduction

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.