The Enfield Heart Failure Community service offers:

• management in the community to prevent admission/re-admission
• review within 28 days (with an aim to review patients within two weeks after discharge from hospital following an admission due to heart failure)
• a mix of clinics (see locations), home visits and telephone consultations based on patient need
• individualised medication titration to ensure patients are on maximum tolerated doses of evidence-based medications (NICE 2018/ESC 2021)
• support with advanced care planning and liaison with palliative care teams for patients with end-stage heart failure
• advice and education offered to help patients/families/carers understand and manage their condition, identify when their condition is changing and how to seek help 
• referrals back to the GP for routine care once the patient is stabilised.

The service has close working links with the hospital-based cardiology and heart failure teams, cardiac rehabilitation nurse specialists, pharmacists, palliative care, voluntary care sector teams, physiotherapists and occupational therapists, mental health professionals and social workers across the region.

It offers training to health care providers for people with heart failure where necessary.

The service operates Monday to Friday, 9am-5pm. The team is offered clinical support and guidance by local cardiologists at North Middlesex University Hospital (NMUH), Barnet and Royal Free NHS Trust, St Bartholomew's Hospital and University College London Hospital (UCLH).

Eligibility Criteria

Inclusions

Any patients with a heart failure diagnosis (confirmed diagnosis on Echo/MRI)  

• HFrEF (LVEF < 40%)
• HFmrEF (LVEF 40-49%)
• HFpEF (LVEF > 50%) with evidence of left ventricular hypertrophy; left atrial enlargement; diastolic dysfunction; right ventricular dysfunction or elevated pulmonary pressures (provided patients have a management plan in place by a cardiologist)
• Patients with inoperable valve disease or who have declined surgery (patients with valve disease for surgical intervention are referred to cardiology/valve teams to be managed)
• Patients living within Enfield borough or one mile over border or can travel to community clinic (accepting that home visits will not be possible if the patient lives out of Enfield borough)
• Patients with a registered GP within North Central London (NCL) ICB  (Barnet, Enfield, Haringey, Camden or Islington)
• Patients over 18 years of age 
• Must be willing to accept the support of the service.

Other variances of patients accepted (following discussion and plan by cardiology team):

• HFrEF post cardiac surgery
• HFrEF post MI evidenced on six-week post MI echo
• Post-partum cardiomyopathy 
• Cardio-oncology
• Amyloidosis

Exclusions

• Echo not available (all referrals without an available echo will be appropriately signposted and followed up with GP or cardiology team as required)
• End-stage renal disease CKD V 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)
• Patients with pulmonary hypertension (under care of pulmonary hypertension team at RFH Trust)
• Patients aged under 18 
• 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
• Patients who decline the support of the service
• Other immediately life-threatening illness, for example, advanced malignancy

How to Refer

Locations

Lucas House

St Michaels Hospital: Hot-desking

Lincoln Road Surgery

Forest Primary Care Centre

St Michaels Hospital