Managing heart failure requires a holistic approach: as well as optimal medical treatment, patients and their families need to have a sufficient understanding of the condition. There also needs to be a service to deliver this care. Heart failure affects about 0.5% of the population, depending on the age of the population, so each general practice has a manageable number of patients. However, the expertise and confidence needed to deliver optimal care to heart failure patients and their families are not widely held in primary care. There is largely a reliance on secondary care to provide community services, led by consultants and delivered by specialist nurses. Within this system patients are usually well served, but sometimes patients fall between the community service and general practice. In Central Manchester there is no community heart failure service. About one in five patients with heart failure were being admitted each year, indicating that heart failure management in the community needed to improve.
