Heart failure service

Symptoms can range from mild to severe and may change over time.

Look out for:

• shortness of breath, especially during physical activity or when lying down
• swelling, particularly in the legs, ankles and feet
• persistent coughing or wheezing, often with white or pink blood-tinged phlegm
• fatigue — feeling constantly tired or weak

If heart failure is suspected, GPs will often request a blood test to measure the levels of natriuretic peptides (BNP or NT-proBNP). Elevated levels of these peptides can indicate heart strain.

Although not definitive, this test serves as a preliminary screening tool and can help determine the urgency of further assessment.

When more detailed assessments are required other tests, like ‘echo’, cardiac magnetic resonance imaging (MRI), electrocardiogram (ECG), or chest X-rays might be employed.

These provide more information on the heart’s condition and its electrical activity, or detect complications like lung congestion.

For all tests, it is essential to let your healthcare provider know of any allergies or existing health conditions, or if you are pregnant.

Preparation might vary depending on specific patient needs and institutional protocols. Always follow the instructions provided by your healthcare team.

Cardiac MRI

Cardiac MRI is a non-invasive imaging method that uses powerful magnets and radio waves to create detailed pictures of your heart and its blood vessels.

What to expect

• You will lie on a table that slides into a large tunnel-shaped scanner.
• The procedure usually lasts between 30 minutes and an hour.
• You may hear loud thumping or tapping noises during the scan.
• It is important to remain still during the scan, to ensure clear images.

Cardiac CT (computed tomography) scan

A cardiac CT scan is a painless imaging test that uses X-rays to take detailed pictures of your heart and its blood vessels.

What to expect

• You will lie on a table inside a doughnut-shaped machine.
• An iodine-based contrast dye may be injected into your vein to improve image quality.
• The scan usually takes less than 10 minutes.
• You might be asked to hold your breath briefly several times during the scan.

Angiogram (cardiac catheterisation)

An angiogram is a test that uses X-rays to view your heart’s blood vessels. A dye is injected into the blood vessels to make them visible under X-ray.

What to expect

• You wil be awake during the procedure but will receive local anaesthesia and mild sedation.
• A small incision is made, usually in your groin or wrist.
• A catheter is threaded through your blood vessels to your heart.
• The dye is injected, and X-rays are taken.
• The procedure typically lasts 30 minutes to an hour, but preparation and recovery add several hours.

ECG (electrocardiogram) 

An ECG is a simple test that records the electrical activity of your heart over time.

What to expect

• This is a non-invasive and painless procedure.
• While lying down, small electrode patches are attached to your skin.
• The ECG usually takes 5 to 10 minutes.
• You will need to remain still and may be asked to hold your breath briefly.

‘Echo’ (echocardiogram)

An echocardiogram, or ‘echo’ is an ultrasound test that uses sound waves to create pictures of your heart’s chambers, valves, walls, and blood vessels.

What to expect

• This is a non-invasive and painless procedure.
• You will lie down, and a technician will apply gel to a handheld device (transducer).
• The transducer is moved over your chest to obtain images.
• The test usually takes 30 minutes to an hour.

Different drugs address varying aspects of heart failure. These include:

• angiotensin-converting-enzyme (ACE) inhibitors, angiotensin receptor blockers or angiotensin receptor/neprilysin inhibitors (ARNIs) such as sacubitril/valsartan
• beta-blockers
• mineralocorticoid receptor antagonists (MRAs)
• GLT2i
• diuretics (‘water pills’)
• digoxin

Remember to take your medication as prescribed and discuss any side effects with your doctor.

Other treatments and support are discussed below.

Implantable cardioverter defibrillator (ICD) 

For some patients with heart failure, the risk of life threatening arrhythmias or sudden cardiac death is heightened.

An ICD offers a potential lifeline. This small device, implanted under the skin, continuously monitors the heart’s rhythm. Should it detect a dangerous arrhythmia, it can deliver electrical shocks to restore a normal heartbeat. 

For heart failure patients, especially those with severely reduced heart function, an ICD can be a crucial preventive measure. It does not replace medication or other treatments, but acts as an additional safeguard against the unpredictable and severe complications of arrhythmias. 

While the prospect of getting an ICD might initially seem daunting, it is essential to consider the protective benefits it offers, especially in the context of heart failure’s inherent risks.

Discussions with a cardiologist will provide clarity on the appropriateness and timing of ICD implantation for individual patients.

Cardiac resynchronisation therapy (CRT)

CRT is a therapeutic approach that holds promise for certain heart failure patients, especially those with symptoms that persist despite standard treatment. 

CRT involves using a special kind of pacemaker, often combined with an ICD, designed to help the heart’s chambers beat in synchronised harmony.

In heart failure, the heart’s chambers can sometimes beat out of sync, reducing the organ’s efficiency. A CRT device coordinates the contractions, improving the heart’s ability to pump blood effectively throughout the body. 

Numerous clinical studies have indicated that CRT not only alleviates heart failure symptoms, but can also reduce hospitalisations and improve survival rates.

As with any medical intervention, the decision to proceed with CRT should be made collaboratively between the patient and their cardiologist, ensuring that the potential benefits outweigh the risks and that it aligns with the patient’s overall treatment goals.

Lifestyle changes you can make

• Activity: engage in safe, regular physical activity, but always consult your healthcare provider first.
• Diet: emphasise fruit, vegetables, whole grains and lean proteins, and limit salt and saturated fats.
• Monitoring: watch your fluid intake and daily weight, and keep track of your symptoms.
• No smoking or alcohol: if you drink, do so in moderation and always consult with your healthcare provider.

Your journey, our support

Heart failure is a condition, not a verdict. With the right care and support, many individuals lead fulfilling lives. Stay proactive, stay informed — you are not walking this path alone. Tips include:

• Educate yourself: understanding your condition empowers you to make informed decisions.
• Stay positive: a positive attitude can improve your quality of life and outcomes.
• Connect with others: join heart failure communities or online forums to share experiences and learn from others.

Support systems in the UK

• NHS services: specialised heart clinics and teams are available across the UK, offering tailored care and rehabilitation programmes for heart failure patients.
• Heart failure charities: the British Heart Foundation and similar organisations offer patient resources, helplines, support groups and educational events.
• Mental health support: living with heart failure can be emotionally taxing. Seek counselling or therapy if you feel overwhelmed, anxious or depressed.

Emergency contact

For severe symptoms or emergencies, call 999 immediately. You can access more detailed resources and support on the NHS website.

Heart failure clinics

Clinician-led heart failure clinics are for patients with suspected or confirmed heart failure.

Patients will be reviewed, and a management plan will be made by the consultant leading the patient’s care.

Clinicians may arrange investigations such as blood tests or different scans of the heart. They will likely suggest medicines or interventions to treat the condition.

If a patient receives a diagnosis of heart failure, then the consultant may involve some other specialists within the team to better support the patient.

If you are in a 'one-stop shop' clinic, you may have an echocardiogram on the same day.

Heart failure specialist nurse clinics

These are nurse-led clinics where specialist nurses assess patients in clinic or via the telephone.

The purpose of these clinics is to: treat symptoms of heart failure such as shortness of breath and leg swelling; to initiate and titrate (find the best dose for) heart failure medications; and to help patients to manage their condition. 

Clinics are run at the Royal Free Hospital, Barnet Hospital and Chase Farm Hospital.

We have a nurse-led heart failure advice line where patients are encouraged to call if they have symptoms of deterioration and can manage those symptoms according to the advice they receive.

Referral to community heart nurses

At times, it may be more appropriate for care to be managed in the community, and in these cases we refer patients to the community heart failure nurses.

Teams in the various catchment areas have different referral criteria based on specific diagnoses. 

Post-discharge clinic

Patients who have been admitted with heart failure will receive an appointment in the nurse-led clinic, usually within two weeks of discharge. The objective of this clinic is to avoid readmission to hospital.

Patients who have concerns regarding heart failure symptoms before their appointment date are encouraged to contact the heart failure nurse advice line.

Pharmacist-led clinic

The pharmacist-led clinic is available to discuss evidenced-based heart failure medication.

The clinic can initiate or increase medicine dosage with careful monitoring of the individual’s blood pressure and renal function (via blood tests).

They can also support patients who are taking multiple medications, who may need further support with managing their drugs.

Heart failure and devices multidisciplinary team meeting

Members of the team from various specialities — including cardiology consultants, cardiac rhythm management consultants, cardiology pharmacists, advanced care specialists and palliative care specialists — meet to discuss options for cardiac devices and assist with complex decision making.

This meeting takes place weekly at Barnet Hospital and the Royal Free Hospital, and includes the community teams.

Diuretic lounge

This service is run jointly by the consultants, registrars and specialist nurses.

It allows patients to be treated with intravenous (IV) diuretic medication used to treat fluid overload, in a day case setting. In appropriate cases, this can be used to avoid hospital admissions.

Referrals are initially assessed by the heart failure nurses to identify whether patients meet the criteria.

‘Virtual wards’

Virtual wards enable patients to receive care at home safety and conveniently rather than being an inpatient in hospital. Patients are asked to monitor their blood pressure, heart rate and weight; this is logged in an app and monitored regularly by the hospital heart failure team. Medication may be altered as required during this time.

Before your appointment

• Please bring a list of all medicines and recent information you have been given by your doctors or healthcare professionals.
• Make a list of your current symptoms and changes in your condition and how you feel.
• Write down any questions or concerns you may have.

If a heart condition is stable, a holiday can be a great way to rest and relax.

Most patients who have stable symptoms can travel — however, if you have been experiencing new or worsening symptoms or have very recently been acutely unwell, you may need consider whether it is safe to do so. Please seek advice from your GP or heart failure team if you are unsure. 

Read useful information on travel with a heart condition on the British Heart Foundation website.

Heart failure and driving

Having heart failure in itself does not mean you cannot drive, however, there are some circumstances in which driving is not permitted by the DVLA. For example:

• if your heart failure symptoms affect your ability to drive
• symptoms distract you when driving
• symptoms occur when you are at rest
• if you have had a heart rhythm problem called ventricular tachycardia (VT) or a shock from a complex device such as an ICD

In the UK, the DVLA advises those with heart failure about potential restrictions, especially for those who experience symptoms at rest or during light exertion.

Patients with more severe stages of heart failure, particularly those who have been advised against driving by their physician, are obliged to inform the DVLA of their condition.

Heart failure is a condition where the heart cannot pump blood effectively to meet the body’s needs. This inefficiency can lead to a cascade of symptoms ranging from fatigue and breathlessness to fluid retention and chest pain.

Over time, especially in the advanced stages, heart failure can significantly impact quality of life, rendering everyday activities challenging and affecting emotional wellbeing.

Palliative care, often misconstrued as end-of-life care, is much more encompassing.

It is designed to provide relief from the symptoms and stress of serious illnesses like heart failure. The goal is to improve quality of life for both the patient and their family or carers.

For heart failure patients, palliative care provides symptom management. Breathlessness, a frequent and distressing symptom, can be alleviated with specific techniques and medications. Pain, fatigue and other physical symptoms are addressed comprehensively.

Beyond physical care, palliative care offers counselling, provides coping strategies and addresses fears, helping patients navigate the intricacies of their condition.

Equally important is the support offered to families. Heart failure does not just affect the individual diagnosed but also their loved ones.

Palliative care teams provide emotional support, decision-making assistance and guidance to loved ones, ensuring that they too have the resources and strength to support patients.