These symptoms can be caused by the disease itself, by co-morbidities, or can result from the side effects of treatment. Pharmacological and non- pharmacological treatments can improve patients quality of life, both in terms of physical functioning and well-being. 2.3 Definition of a specialist The term specialist is applicable to a wide range of healthcare professionals; however, within the context of this guideline, the term specialist is used in relation to establishing the diagnosis of heart failure and more complex decisions on the management of heart failure and its multiple causes. Throughout this guideline the term specialist denotes a physician with sub-specialty interest in heart failure (often a consultant cardiologist) who leads a specialist multidisciplinary heart failure team of professionals with appropriate competencies from primary and secondary care (see chapter Chronic Heart Failure Introduction NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: 978-1-4731-3093-7 12). The team will involve, where necessary, other services (such as rehabilitation, other acute medical specialities, older person s care and palliative care) in the care of individual patients. Unless otherwise specified, within this guideline specialist assessment or management refers to assessment or management by this specialist multidisciplinary heart failure team. The team will decide who is the most appropriate team member to address any particular clinical problem. 2.4 Definitions used in the guideline Initial research into heart failure concentrated on patients with heart failure due to impaired contraction of the left ventricle, also known as left ventricular systolic dysfunction (LVSD). Consequently, therapeutic interventions have primarily been tested in this group of patients. Over the last 20 years it has become evident that almost half the patients with clinical signs of heart failure do not have LVSD. This proportion is increasing 353 . 