ISBN: 978-1-4731-3093-7 9 Referral and approach to care The update to the heart failure guideline includes topics where new evidence has emerged since the publication in 2010. A review of new evidence published after 2010 was carried out in order to determine whether any changes to current recommendations where likely to be required. The decision on which topics to include in the update of the guideline was made following consultation of the scope. This section includes multidisciplinary team working,transition and continuity between different heart failure care settings and information and support needs. The following topics were not within the scope of the update. For more information refer to Appendix R, the 2003 guideline: Discharge planning Support groups Anxiety and depression See See NICE s guideline on depression in adults with a chronic physical health problem 9.2 Team working in the management of heart failure Heart failure is a complex disorder whose management involves a number of professional groups. Members of different professional groups contribute their experience and expertise to meet the complex needs of the patients. For the care to be optimised, the efforts of these professionals are best delivered through multi-disciplinary team (MDT) working. Multidisciplinary teams are well established to support people with heart failure in the UK. A variety of models of care exist in heart failure and studies have documented the outcomes achieved by these different approaches. The role of the MDT in the care of patients with heart failure care was recognised in the NICE guidelines published in 2003. Since then has accumulated that has investigated the composition, competencies, needs for support, and the timing of different contributions of members of MDTs over a patient s journey. 