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 . Despite this 20% of patients are readmitted within 30 days of initial admission and 50% within one year though commonly due to non-heart failure causes45 .Younger patients do better, as do patients reviewed by specialist as opposed to general services.Rates of drug prescription have increased, but one-year mortality remains significant. The evidence suggests a trend of improved prognosis for heart failure in the last 10 years74 but this is not found in all studies331 . Patients indicate that their management of heart failure impacts beyond just the clinical management with effects on social relationships, emotional well-being and psychological status. As well as NHS costs, heart failure places a burden on other agencies such as social services and the benefits system, and of course on the patients with heart failure, their families and carers. For patients and their carers, the costs are more difficult to quantify, but the burden is both financial and via adverse effects on their quality of life. The financial costs of heart failure to the patient and family arise from prescription charges (in patients under the age of 60), attendance at GP surgeries and outpatient clinics, hospital stays, modifications to the home and loss of earnings due to absence from work or loss of employment thus leading to adverse pressures on the family. Quality of life is affected by the physical limitations imposed by the condition, the social limitations that follow from this and the emotional problems that may also arise146 . These symptoms can be caused by the disease itself, by co-morbidities, or can result from the side effects of treatment. 