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Heart failure is complex syndrome that can result from any structural or functional cardiac disorder that impairs the ability of the heart to function as a pump to support a physiological circulation. It is characterised by symptoms such as breathlessness and fatigue and signs such as fluid retention[1].   The prevalence of chronic heart failure (CHF) is between 3 and 20 patients per 1,000, increasing to at least 80 cases per 1,000 in patients aged 75 years and over.  The annual mortality is between 10 and 50 per cent depending on the severity of the disease[2]. A practice population of 5,000 people over the age of 55 years should have approximately 155 people with a diagnosis of heart failure on their register[3].   Previously, without proven effective treatments, heart failure was often under-diagnosed, misdiagnosed or even ignored. Clinical trials have now shown that appropriate treatment, with ACE inhibitors, angiotensin receptor blockers and beta-blockers can improve the survival and quality of life for people with heart failure.   The cornerstone of diagnosis of CHF is the echocardiogram. With recent improved access to echocardiography for GPs (open access echocardiography) heart failure is increasingly managed in a primary care setting with the help of community heart failure specialist nurses and practice nurses trained in the management of long term conditions. [1] NICE Guidelines, Chronic Heart Failure, 2003 [2] National Service Framework for Coronary Heart Disease, London 2003 [3] Figures extrapolated from the Hillingdon Heart Failure Study, 1999     Compiled by Ms R. Scott Community Heart Failure Specialist Nurse

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