Heart failure (Hertfordshire)

We support patients diagnosed with heart failure.

The community heart failure team is a nurse led service and comprises of heart failure specialist nurses with clinical support from a consultant cardiologist. We assess, treat, support and educate patients diagnosed with heart failure who live West Hertfordshire. We also support patients in the virtual heart failure ward and offer advice and guidance to GP and other community services.

The aim of our service is to ensure that all patients receive evidence-based treatments based on national and international heart failure guidelines which best suit individual needs. Patients are offered guidance and education to help them understand and self-manage their condition, if able, therefore improving their health status and quality of life.

To support with symptom management we have strong links with local palliative teams who help to support people living with life limiting conditions and are able to access various supportive and rehabilitative services which are conducted at local hospices which are Hospice of St Francis in Berkhamsted, Peace Hospice Watford and Rennie Grove St Albans.


We provide home visits to primarily housebound patients and hold a number of community clinics throughout West Hertfordshire. Patients are allocated a community heart failure specialist nurse linked to a GP Practice.

People can be referred to our service by:

  • The hospital based heart failure team
  • Hospital consultants, usually following discharge from hospital.
  • Your GP
  • A GP practice nurse
  • District nurses
  • Secondary and Primary Care Specialist Nurses & Community Matrons
  • Self referral if already known to our service

Patients must have a diagnosis of heart failure, confirmed by echocardiogram, before they can be referred to the clinic. Please ensure a copy of up-to-date echo is sent with the patient’s referral. If not there will be an unfortunate delay in review of your patient.

Access and download the referral form

Acceptance criteria:

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

•       HFrEF – EF ≤40%

•       HFpEF –EF ≥40% with evidence of diastolic dysfunction or RV dysfunction or severe valvular disease for medical management

Exclusion Criteria:

•       ECHO not available confirming Heart Failure (all referrals without an available echo will be appropriately sign posted and followed up with GPs referrers and acute partners as required)

•       End stage renal disease CKD V egfr ≤ 15/ Patients on dialysis

•       CKD IV egfr ≤30 without a management plan from cardiologist/renal consultant

•       Patients awaiting AVR/MVR

•       Patients echoed in atrial arrhythmias with HR exceeding 100 bpm require rate control and re-echo before referral

•       Immediately post MI- Must have post MI echo 6 weeks

•       HFpEF patients that are not on a medium dose loop diuretic (80mg Furosemide or Bumetanide equivalent) and with no recent HF admission.

Heart failure is when the heart becomes less effective at pumping blood around the body. The term ‘heart failure’ can sound quite frightening, so it might be helpful to think of it as: ‘My heart is failing to work as well as it should, and needs medicine to help it work better.’ Many people with heart failure can have a good quality of life. You can have some control over your condition by taking your medicines and by making changes to your lifestyle. And for some people, other types of treatment can help.

How your heart works

To understand what heart failure is and what causes it, it can help to know about how your heart works:

  • Your heart is a muscle that pumps blood around your body, delivering oxygen and other nutrients to all your cells.
  • There are two sides to the heart – the right side and the left side.
  • Blood from your body enters the right side of your heart. From here, the heart pumps the blood to the lungs, where the blood takes up oxygen.
  •  Oxygen-rich blood then enters the left side of the heart. From here it is pumped through the aorta (the largest artery in the body) to all parts of your body.
  •  There are four valves inside the heart, to make sure that the blood flows in the correct direction.

What causes heart failture?

There are many reasons why heart failure may happen. The most common causes are:

  • a heart attack
  • high blood pressure
  • problems with the heart valves, and
  • cardiomyopathy (a disease of the heart muscle)
  • a viral infection affecting the heart muscle
  • congenital heart problems (heart problems you’re born with)
  • an abnormal heart rhythm (arrhythmia)
  • some lung diseases
  • thyroid gland disease
  • anaemia (lack of oxygen-carrying haemoglobin or red blood cells in your blood)
  • some types of chemotherapy
  • alcohol or recreational drugs.

In some cases, the cause of heart failure is unknown.

What are the signs and symptoms of heart failture?

The main signs and symptoms of heart failure are:

  • being short of breath, when you’re either resting or being active
  • swelling of your ankles, feet, legs, or abdomen (stomach area)
  • fatigue (feeling unusually tired). These signs and symptoms may come on suddenly – for example, after a heart attack – or may develop slowly over weeks or even months.

What causes these symptoms?

Heart failure happens because your heart is not pumping as well as it should. This can cause a number of things. It can lead to a build-up of fluid that backs up into the lungs. This results in ‘congestion’ and causes breathlessness. It’s a bit like a traffic jam - because blood is not pumped to the kidneys properly, the kidneys can retain salt and water. This extra fluid in your body can cause swelling in your ankles, feet or legs, or in the small of your back, abdomen or groin. The extra fluid can also cause sudden weight gain. Heart failure can also cause fatigue because your heart may not be able to deliver enough blood and oxygen to the muscles in your body.

Can heart failure be cured?

Unfortunately, heart failure can’t be cured yet. But with treatment and management of your symptoms and lifestyle, many people can lead a full and good-quality life.

Could my heart failure get worse?

Your condition may not necessarily get worse, but unfortunately some people do find it gets worse over time. However, taking your medicines, controlling your symptoms and making changes to your lifestyle can all help to keep you as well as possible. Treatments are constantly being improved and new ones are becoming available.

Could having heart failure shorten my life?

It’s not possible to tell anyone with heart failure how long they’ll live for. Heart failure affects different people in different ways. It does shorten the lives of some people, but others live with heart failure for many years. Your outlook will depend on the cause of your heart failure, your age, your symptoms and your general health. Talk to your doctor or nurse if you have questions about this.

Is there a risk of dying suddenly?

Heart failure can cause changes to the structure of the heart muscle, which can affect the electrical activity of the heart. Some people with heart failure are at risk of dying suddenly because they may develop a life-threatening heart rhythm. This can lead to a cardiac arrest (when a person’s heart stops pumping blood round their body and they stop breathing normally). If you’re at risk of dangerous heart rhythms, your doctor can prescribe medicines for you to reduce the risk. If you’re at high risk of developing a life-threatening heart rhythm, your doctor may suggest that you have an ICD (implantable cardioverter defibrillator) implanted.

What can you do to help yourself?

People can often manage the symptoms of heart failure effectively – and improve their quality of life – by making changes to their lifestyle. Making these changes and taking your medicines as prescribed can help to slow down the progression of your heart failure. Some self management strategies you can follow are:

• Weigh yourself regularly

• Watch the amount of fluid you have each day

• Control your blood pressure

• Cut down on salt – do not use Losalt

• Limit your alcohol

• Keep to a healthy body weight

• If you smoke, stop!

• Keep active

Weigh yourself regularly

If you have heart failure, a sudden increase in weight could mean that there is a build-up of too much fluid in your body. It’s a good idea to keep a record of your weight. Weigh yourself at the same time every day, preferably first thing in the morning. If you notice that your weight goes up by about 1-2 kilo (about 3-4 pounds) in 2-3 day, you’re probably beginning to build up fluid in your body. You may also start to feel a little out of breath and may notice some swelling around your ankles, or feel bloated. If you feel OK, continue to keep an eye on your weight, but if you’re worried, contact your nurse or doctor. If the weight gain continues and you notice an increase over three days, or if you start getting more out of breath or have more ankle-swelling, you should talk to your nurse or doctor. People can often manage the symptoms of heart failure effectively – and improve their quality of life – by making changes to their lifestyle. Making these changes and taking your medicines as prescribed can help to slow down the progression of your heart failure.

Watch the amount of fluid you have each day

You may be advised to limit the amount of fluid you have each day. Keep a record of your fluid intake and remember to include things like soup. If you’re not sure how much fluid you should be having or whether you need to restrict your fluid, talk to your doctor or nurse.

Control your blood pressure

High blood pressure can put a strain on your heart. Staying a healthy weight, keeping active and taking the medicines your doctor has prescribed for you will help to control your blood pressure and reduce the workload on your heart. Cutting down on salt can help keep your blood pressure down. Your doctor or nurse will want to check your blood pressure regularly or may ask you to check it yourself at home.

Cut down on salt

Too much salt in your diet can make your body hold on to water. Also, having too much salt can affect the way your water tablets work. So it’s important to watch how much salt you have. Aim to have less than 6 grams a day – which is about a teaspoonful.

  • Don’t add any salt to your food at the table
  • Avoid eating foods that contain a lot of salt, such as cheese, bacon, canned meat, sausages, crisps, smoked fish and canned and packet soups. Use food labels on products to help you choose lower-salt ingredients and meals.
  • Choose alternatives to salt when cooking or preparing food. Use herbs and spices to add flavour instead.
  • Avoid salt substitutes. These are not recommended if you have heart failure.

Limit your alcohol

Drinking too much alcohol can sometimes make the symptoms of heart failure worse, so stay within the sensible limits for alcohol. Men and women should not drink more than 14 units of alcohol a week. You should have several alcohol-free days each week. These guidelines apply whether you drink regularly or only occasionally. Talk to your doctor or nurse about what’s a safe amount for you to drink. Keep to a healthy body weight If you’re overweight, your heart has to work harder to pump the blood around your body. Keeping to a healthy weight will help reduce the risk of health problems. The best way to lose weight is to cut down on your calorie intake and increase your physical activity.

If you smoke, stop!

If you’re a smoker, stopping smoking is the single most important thing you can do to live longer. Stopping smoking will also reduce the workload on your heart and will help improve your symptoms. Ask your doctor or nurse for information, support and advice about ways to help you quit. Or you can call the Smokefree National Helpline on 0300 123 1044, or visit their website at www.nhs.uk/smokefree.

Keep active

Regular physical activity can help to improve your energy, stamina and fitness. This can help you to improve or cope with your symptoms, keep your heart healthy, and increase your sense of well-being. Recommended activities include walking, dancing or cycling. These activities should make your heart beat a little faster and leave you feeling a little short of breath. Your doctor may ask you to avoid strenuous activities such as carrying heavy objects, doing heavy DIY or gardening, and also vigorous sports such as squash or weight-lifting.

Start at a level that suits you and set realistic goals about what you can do. If you’re limited in how much you can do, being active can be a challenge, but even a small amount of activity every day is good for your heart. Ask your doctor or nurse about how much activity you should be doing and how you can build up your activities gradually.

Try and be active every day. Each time you start your activity, begin slowly for the first few minutes and build up gradually. Before you finish, take time to slow down, and don’t stop suddenly. Try not to overdo the amount of activity you do. Overdoing things can leave you exhausted, which can limit your activity in the following days. You may find it helpful to spread your activity throughout the day. Try doing a small amount each time, along with regular rest periods. If you notice that you’re getting more breathless than usual, or if you feel unwell or are in pain, slow down and stop, and tell your doctor.

You may be invited to a cardiac rehabilitation programme. The aim of the programme is to help you recover quickly and to get you back to as full a life as possible. The programmes usually include exercise sessions (which can be adapted to suit your needs), education sessions on healthy lifestyles, and psychological support. To find out more, visit the cardiac rehabilitation webpage.

Appointments are made by our heart failure nurse specialists from Monday to Friday between 9am and 5pm (excluding bank holidays).

Out of hours: Please contact your GP or your local out of hours GP or 111. In the event of an emergency call 999.

Location: Hemel One, Boundary Way, Hemel Hempstead, Hertfordshire, HP2 7YU

Tel: 03000 200 656, Option 5 or email CLCHT.westherts.communitycardiology@nhs.net

Follow us on Twitter: @CLCHeartfailure

For further information and advice for heart failure, check out these websites:


Peer support group for patients and carer’s  living with Heart Failure

Share a cuppa and conversation with others living with heart failure

Held first Thursday of every month from 10.30am -12pm

Location: King Charles the Martyr church café, 368 Mutton Lane, Potters Bar, EN6 3AS

Watch this space for new groups!

We would appreciate feedback on your recent experience of our service.

For our Heart Failure Service, please scan the following QR Code to complete our short survey:


Alternatively, you can use the following link to access the survey, by clicking on this link.

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