Based on this evidence, the committee agreed that a nursing element was needed, and emphasised that a specialist heart failure nursing competency was necessary; as the evidence suggested that it was not possible to get the same clinical improvements from generalist nurses. There was also evidence that the presence of prescribing expertise (whether by a nurse prescriber or pharmacist) can improve the prescription of some medications, and the committee agreed that the MDT should also include specific prescribing expertise. The committee also noted that there was evidence that involvement of the patient s primary care team was shown to be beneficial, and this was in accordance with the negative experiences of some of the committee members when primary care was not involved in the management plans. It was felt that the multidisciplinary specialist HF team members provide input to the management of patients with heart failure defined above in collaboration with their primary care team. In this way, the primary care team can help facilitate communication and collaboration between healthcare professionals wherever the patient s care is being delivered across different settings. This may include a GP who has completed a course for special interest registration Trade-off between net clinical effects and costs Five relevant economic evaluations were included in this review which compared an MDT to usual care. All of these studies were assessed as partially applicable with potentially serious or very serious limitations. One economic evaluation assessed high risk patients receiving a mid-length (3-6 month) home-based MDT clinic including a cardiologist, heart failure nurse, palliative care physician, palliative care nurse, physiotherapist and Chronic Heart Failure Referral and approach to care NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: 978-1-4731-3093-7 occupational therapist. This was based on the PREFER trial by Brannstrom et al. 