It is estimated that the total annual cost of heart failure to the NHS is around 2% of the total NHS budget: approximately 70% of this total is due to the . Admissions tend to be protracted: The median length of stay is 6-9 days depending on the requirement for additional specialist cardiology management235 . Readmissions are common: about 1 in 4 patients are readmitted in 3 months. Associated co-morbidities account for a substantial proportion of admissions of people with a diagnosis of heart failure45 . The costs increase with disease severity, with the healthcare costs for patients with the most severe symptoms between 8 and 30 times greater than those with mild symptoms35 . Patients on GP heart failure registers, representing prevalent cases of heart failure, continue to be at significant mortality risk, with a ten-year survival of 27% as compared to 75% in the age- and sex- matched general population in 2009329 .The prognosis is poorer in patients with co-morbidities329 and may be similar to patients with cancer20 . On average, a GP will look after 30 patients with heart failure and suspect a new diagnosis of heart failure in, perhaps, 10 patients annually. Those who work in more deprived areas are likely to have more cases. The cost of GP consultations has been estimated at 50 million per year, with an additional 50 million for GP referrals to outpatient clinics. In addition, community-based drug therapy costs the NHS around 150 million per year. The recent National UK Heart Failure audit of acute heart failure suggests continuing improvements in heart failure diagnosis and management. In-patient mortality has fallen from 15% in 2009 to 8.9% in 2016 leading to more patients requiring long-term care in the community235 . 