Managing Heart Failure @home: An opportunity for excellence

Following a successful launch event for professionals on the 18 July, National Clinical Director Nick Linker outlines an innovative approach supporting people to manage heart failure at home, using remote monitoring and self-management tools.

Living with heart failure is becoming increasingly common due to our ageing population and improving medical care. In 2018, 920,000 people were living with heart failure in the UK, with around 200,000 new diagnoses made annually. People living with heart failure require significant input from NHS services. Caring for heart failure patients accounts for 2% of the total NHS budget and for 5% of all emergency hospital admissions in the UK.

Given its prevalence, effective heart failure care is a priority. Improving recognition of heart failure, diagnosis and understanding of the condition and its management are important. Heart failure is often diagnosed late, with 80% of diagnoses made during emergency admissions. We see high rates of hospital admission and readmission for those living with heart failure. We know admission rates vary between regions and socio-economic class. We also recognise that integration between the different parts of the NHS system can vary and lead to disjointed care and poor patient experience.

Managing Heart Failure @home is working with professionals to support people to manage their own health and to stay well at home, using remote monitoring, supported self-management and education. This can minimise unnecessary face-to-face appointments and reduce avoidable hospital admissions and readmissions. The @home approach can work alongside virtual wards, supporting patients who require acute care in their own homes. Experienced specialists in heart failure care will ensure any remote interactions are clinically safe and appropriate, ensuring consideration of individual needs.

Managing Heart Failure @home’s three core elements

  1. Personalised care. This means listening to what matters to the individual and helping them to have the knowledge, skills and confidence to manage their own health. It also means shared decision making becomes the norm as empowered patients become equal partners in their care. Best practice will see teams referring patients to local social prescribing link workers and community support to ensure their needs are considered holistically. Heart failure care delivered using a personalised care approach is exemplified by REACH-HF (Rehabilitation EnAblement in CHronic Heart Failure), a facilitated evidence based cardiac rehabilitation for heart failure and self-management programme for use at home.
  2. Remote support & monitoring. This means maximising the use of technology where appropriate, to support more people to remotely monitor their symptoms. Patients can recognise and report if their condition deteriorates and where appropriate, share physiological measures allowing clinicians to safely work remotely, offering advice and adjustments in medications. This allows heart failure teams to take timely action if someone’s condition deteriorates. This can include using telephone and web-based communication or apps to send information directly to clinicians. Imperial College Healthcare NHS Trust has redesigned its heart failure pathway and patients are now given Bluetooth-enabled remote monitoring devices which send recorded measurements directly to clinicians to support care.
  3. Integrated care. Improvement of coordination between primary, community and secondary care allows for better continuity of care and a better experience for the patient and clinicians. Classifying the needs of patients and a way to share care between teams allows people to get the right care at the right time from the right team.  Liverpool’s Integrated Virtual Multispecialty Multi-Disciplinary team has been spearheading this approach, bringing together clinicians to address people’s holistic needs, in order to improve clinical outcomes whilst minimising the need for multiple appointments.

This approach is about enabling heart failure services to work in the most efficient way possible. It is not about stopping face-to-face care and moving into an entirely digital environment. We recognise that not everyone has access to digital technology, so non-digital and face-to-face alternatives must always be offered. Flexibility in the system will help to enable these many ways of working.

In your area, it is likely that you are already working in new ways, necessitated by the COVID-19 pandemic. Managing Heart Failure @home is not intended to replace the great work you are already doing. It is an opportunity for teams to embrace the elements of this work which will further improve patient care. NHS England is now looking for teams to become early adopter sites (login required) to trial the care described here. Are you ready to apply?

For more information on Managing Heart Failure @home, including accessing the case studies mentioned above, visit the FutureNHS page (login required), or contact

Professor Nick Linker

Professor Nick Linker was the National Clinical Director for Heart Disease for NHS England (2019-2024). He led on the implementation of the NHS Long Term Plan for heart disease, the development of heart disease policy for Specialised Commissioning, and was Chair of the Cardiac Services Clinical Reference Group. He was Clinical lead for the Cardiac Transformation Programme and has responsibility for the national cardiac registries.

He trained in Manchester Royal Infirmary and St George’s Hospital, London and was appointed as a consultant cardiologist with an interest in cardiac electrophysiology at South Tees Hospitals NHS Foundation Trust in 1998 and Honorary Professor at Teesside University in 2021. His clinical practice focused on arrhythmia and syncope management and cardiac implantable electronic devices.

Professor Linker was President of the British Heart Rhythm Society and Honorary Secretary of the British Cardiovascular Society. He was integral in developing UK standards for cardiac implantable electronic devices, electrophysiology and lead extraction and developed guidelines on MR scanning in patients with cardiac devices, peri-operative management of cardiac devices and end of life care pathways for cardiac device patients.