9.2.6 Recommendations and link to evidence Recommendations The core specialist heart failure multidisciplinary team (MDT) should work in collaboration with the primary care team, and should include: a lead physician with a subspecialty interest in heart failure (usually Chronic Heart Failure Referral and approach to care NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: 978-1-4731-3093-7 a consultant cardiologist) who is responsible for making the clinical diagnosis a specialist heart failure nurse a healthcare professional with expertise in specialist prescribing for heart failure. [2018] The specialist heart failure MDT should directly involve, or refer people to, other services, including rehabilitation services, and tertiary and palliative care, as needed. [2018] The specialist heart failure MDT should: diagnose heart failure give information to people newly diagnosed with heart failure (see manage newly diagnosed, recently decompensated or advanced heart failure (NYHA [New York Heart Association] class III to IV) optimise treatment start new medicines that need specialist supervision continue to manage heart failure after an interventional procedure such as implantation of a cardioverter defibrillator or cardiac resynchronisation device manage heart failure that is not responding to treatment. [2018] Relative values of different outcomes The critical outcomes were identified as all-cause hospitalisations, mortality and quality of life. Important outcomes included medicine optimisation (including the proportion of people prescribed medication and the proportion taking the medication as prescribed). Also important were outcomes felt by the committee to indicate potential adverse events from over-treatment: renal failure, hyperkalaemia and hypotension. Patient and carer preferences, and dying in preferred place of death for palliative care patients, were also considered important, but these outcomes were not reported by any study. Quality of the clinical evidence Twenty two studies (23 comparisons) were identified. 