The Community Heart Failure Nurse Service (CHFNS) comprises of a team of specialist nurses skilled in the management of patients with heart failure.

The service offers:

• heart failure management in the community to prevent admission/re-admission
• patient reviews within two weeks after discharge from hospital following a heart failure admission
• a mix of clinics (see Locations), home visits and telephone consultations based on patient need
• titrate medication to ensure patients are on maximum-tolerated doses of evidence-based medications (NICE 2025/ESC 2023)
• support with end-of-life care for heart failure patients
• patient/families/carers education to assist with self-management
• referrals back to the GP for routine care once the patient is stabilised.

This service operates Monday to Friday, 9am-5pm. The team is offered clinical support and guidance by local cardiologists at Whittington Health (WH), University College London Hospital (UCLH) and North Middlesex University Hospital (NMUH).

Eligibility Criteria

Inclusions

• aged 18+ and registered with a GP in Islington or Haringey
• Confirmed diagnosis of heart failure with HFrEF, HFmEF and HFpEF; the diagnosis must be confirmed by an echocardiogram and the patient must have been seen by a cardiologist or a physician with a specialist interest in heart failure in line with NICE guidelines (this information must be provided on referral to the CHFNS). The CHFNS will accept patients with heart failure with normal left ventricular ejection fraction (HFpEF) with a clear management plan completed by the named cardiologist on referral and with the following criteria only:
  • normal left ventricular ejection fraction (LVEF 50% or more on echocardiography) with moderate or severe left ventricular diastolic dysfunction and dilated left atrium (LAVI >38 ml/m2) and/or left ventricular hypertrophy (indexed LV mass >110 g/m2 for men and >99 g/m2 for women), or
  • normal left ventricular ejection fraction (LVEF 50% or more on echocardiography) with severe valvular dysfunction.
• newly diagnosed or unstable confirmed heart failure commencing on/or support with medication/treatment optimisation
• patients requiring specialist education, advice, information and support at any stage in their disease pathway from diagnosis through to palliative care stages
• end-stage heart failure.

Exclusions

• Patients aged under 18
• Echo not available (all referrals without an available echo will be appropriately signposted and followed up with GP or cardiology team as required)
• Patients will not be accepted within six weeks of myocardial infarction, coronary artery bypass graft surgery, percutaneous coronary intervention and/or valve surgery, and will require repeat echocardiogram to reassess left ventricle function to confirm chronic heart failure by the referrer
• Acute myocardial infarction within six weeks of referral with subsequent heart failure
• Patients requiring hospital transfer for cardiology intervention
• Patients who refuse to receive care from the team 
• Pregnant patients
• Normal LV function with end-stage renal disease CKD 4 0r 5 with eGFR ≤ 15/ patients on dialysis
• Patients awaiting valve surgery (AVR/MVR)
• Patients echoed in atrial arrhythmias with heart rate exceeding 100bpm require rate control and re-echo before referral
• Immediately post MI: must have echo six weeks post MI
• Patients with COPD and Cor pulmonale (advice may be offered to respiratory team for management of diuretics)
• Normal LVEF with primarily pulmonary hypertension (under care of pulmonary hypertension team at RFH Trust)
• HFpEF patients that are not on a medium-dose loop diuretic (80mg Furosemide or Bumetanide equivalent) and with no recent HF admission
• Patients registered with a GP outside NCL
• Other immediately life-threatening illness, for example, advanced malignancy
• Aggressive/abusive behaviour
• Non adherence with mental capacity
• DNA two consecutive appointments or cancel two in under 24 hours consecutively
• HFPEF with no management plan from cardiologist
• CKD IV at discretion of cardiologist and renal team (eGFR15-30)
• Patients with significant valve disease awaiting surgery
• Stable symptoms and medications optimised. 

How to Refer

Locations

Hornsey Rise Health Centre

Hornsey Central Neighbourhood Health Centre

Lordship Lane Primary Care Centre

River Place Health Centre