Pathways could be devised Chronic Heart Failure Referral and approach to care NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: 978-1-4731-3093-7 locally, but the committee felt that it was important that patients with heart failure could contact the heart failure clinic or service if requiring advice or urgent care. It was acknowledged that two way communication between heart failure specialists and GPs is essential to ensure patients are well managed. Specialists need to provide a clear plan to allow medication lists to be updated and GPs also have a responsibility to inform the specialist team when the condition of the patient changes. The ideal system would be to allow all members of the MDT to access hospital, community and GP notes. However this is not yet possible in most areas. Role of specialist HF services: The committee acknowledged that local dialogue about what HF services should provide for people with CHF might be useful, but may not be practical. The reports of the complexity of treating the comorbidities of patients with CHF, the nature of sub-speciality medical training, and the lack of a universal information system, highlighted the fact that the general practitioner, or another generalist such as a geriatrician, should be actively involved throughout the heart failure pathway. It was felt that HF specialists should primarily be involved in HF optimisation, while collaborating with other healthcare providers, who would be providing for the wider needs of patients. Trade-off between net effects and costs No published economic evaluations were identified. The committee agreed that ensuring a care plan was in place and shared with the patient and necessary healthcare professionals was important to improve current barriers in co-ordination and communication for people with heart failure. 