Chronic Heart Failure Referral and approach to care NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: 978-1-4731-3093-7 The GP members of the committee spoke about their current involvement in the care of people with HF. They felt that it was essentially the same as for any other patient with a long term condition, and approached it in the same way. However, HF was among the most challenging conditions to manage, as people with HF tend to have multiple, complex comorbidities. This led the committee to think about including aspects of the multi-morbidity guidance when thinking about reviewing and co-ordinating care for people with HF. The committee highlighted an important sub-population of HF patients, being those that are housebound. It was recognised that they are often not reviewed by HF clinics, and not seen in the GP surgery, and therefore perhaps not routinely seen by the primary healthcare team either. It was felt that some people in these circumstances only received care once they were acutely unwell. The committee intended that these patients should be included in the recommendations regarding six-monthly review. It was reported that, in one example, reviews for housebound patients with HF were sometimes delegated to district nurses. The committee felt that HF monitoring and review should be done by someone with competencies in clinical examination and medicines optimisation. Chronic Heart Failure Referral and approach to care NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: 978-1-4731-3093-7 9.4 Information and support needs regarding diagnosis and prognosis Communication is the one of the key determinants of successful management of chronic diseases. The diagnosis of heart failure is often a shock to patients. Heart failure is a complex disorder which requires active participation of patients in its management. 