The handbook of multidisciplinary
and integrated heart failure care

Call to action

We call on governments to recognise heart failure (HF) as an urgent sustainability challenge for 21st-century healthcare systems. Governments across Europe must:

  • Have a formal strategy on HF and the changing impact it will have on the healthcare system and society, including future scenario-modelling. This should be developed in close consultation with patient and clinical advocates.
  • Invest in sustainable, specialist HF care models outside of acute care, for example HF specialist nurses and HF outpatient centres. They should also promote professional education and, where appropriate, additional specialist accreditation for GPs, internists, primary care nurses and expert patients.
  • Ensure national guidelines and local care pathways embed the vision of quality in routine delivery, working with professional societies, patient advocacy groups and healthcare providers to do so.
  • Prepare robust and public national audits of performance to ensure accountability to citizens on patient survival, quality of life and experience of care, and to guide investment and incentives. The safe reduction of hospital readmissions should be a major strategic goal, indicating a sustainable approach to HF care.



Governments must measure and improve key aspects of HF care. We call on decision makers to demonstrate measurable improvement for the following minimum standards and core indicators of quality for all HF patients:

  • Specialist-led diagnosis. It is vital to achieve a definitive diagnosis with an echocardiogram, ensuring the underlying causes of HF are fully understood, addressed and communicated to patients.
  • Natriuretic peptide (NP) testing. This should be a routinely available tool in both primary and secondary care settings.
  • Specialist-led care in hospital. Patients should receive input from a cardiologist and HF specialist nurse.
  • Hospital discharge with a care plan. Discharge plans should include clear points of contact and timely follow-up by specialists.
  • Cardiac rehabilitation, patient therapeutic education and psychological support. HF care must be built on the maximum engagement of patients.
  • A shift in management of HF from the acute to primary care setting. This shift should occur wherever it is safe and effective to do so.