Heart failure is a common, chronic and progressive condition that contributes substantially to cardiovascular morbidity, hospitalisation and health service use in Australia. It is a major driver of recurrent admissions and ongoing demand for acute, community and specialist care.
In NSW, cardiovascular conditions remain a leading cause of hospitalisation and health service use. Heart failure accounts for a significant proportion of this burden, alongside coronary heart disease and stroke.
Why these standards matter
Care for people with heart failure often spans multiple settings and providers, including primary care, community services, emergency care, inpatient services and specialist outpatient care. Without clear, shared expectations, variation in clinical practice and care coordination can lead to fragmented care experiences, avoidable hospitalisations and poorer outcomes.
The NSW Heart Failure Care Standards:
- support consistent, high‑quality care across NSW
- promote early identification, prevention and risk management
- strengthen continuity and coordination across the care continuum
- embed person‑centred care and shared decision‑making approaches
- support improved outcomes, experiences and equity for people living with, or at risk of, heart failure.
The standards provide a common foundation to guide practice, support improvement and enable more seamless care for people living with heart failure.
The stages of heart failure
People need different types of care at different stages of the patient journey, from being at risk through to advanced heart failure. We aligned each standard to the stage where it is most relevant.
We recognise that an individual's care needs are also influenced by symptom burden and functional status, commonly described using the New York Heart Association (NYHA) classification.
Clinical characteristics: patients without symptoms or signs, structural heart disease or cardiac biomarkers but who have risk factors, e.g. hypertension, cardiovascular disease, diabetes or metabolic syndrome, obesity, positive family history. These patients require monitoring and should undertake lifestyle change, as appropriate.
Care: prevention and risk factor management are led through primary care and community-based services.
Clinical characteristics: patients without symptoms or signs but who have evidence of structural heart disease, abnormal cardiac function or filling pressure or elevated B-type natriuretic peptides (BNPs) and/or cardiac troponin. Other causes of elevated biomarkers have been excluded, e.g. acute coronary syndrome, chronic kidney disease and myopericarditis.
Care: investigation, management of underlying cardiovascular disease and prevention of progression are led through primary care, with specialist consultation or shared care according to clinical findings and complexity.
Clinical characteristics: patients with structural heart disease with current or previous symptoms of heart failure. These patients require optimised pharmacological treatment, in addition to lifestyle changes and supported self-management, to reduce symptoms, improve quality of life and decrease the risk of hospitalisation and death. Trajectory usually involves new onset heart failure, resolution of symptoms, persistent heart failure and worsening heart failure.
Care: coordinated multidisciplinary care is provided across care settings, including primary care, community, virtual and hospital services, with access to specialist heart failure and rehabilitation services as needed. Stable patients may be managed primarily in the community, with specialist involvement for diagnosis, treatment optimisation, deterioration or increasing complexity.
Clinical characteristics: patients with severe, persistent symptoms that signficantly limit daily activities and are associated with recurrent hospitalisations, despite optimised guideline-directed medical therapy.
Care: specialist-led multidisciplinary and supportive care is provided in partnership with primary and community care. This includes consideration of advanced therapies, proactive discussions around goals of care, symptom management and palliative care based on the person's needs and preferences.
Disparities of outcomes
The impact of cardiovascular disease is not shared equally. Aboriginal and Torres Strait Islander peoples experience significantly higher rates of hospitalisation for cardiovascular disease compared with non-Aboriginal people. This includes higher rates of heart failure and coronary heart disease. These disparities reflect ongoing inequities in access to prevention, early intervention, culturally safe care and continuity of care.
People living in rural and regional NSW also experience barriers to specialist services, multidisciplinary care and ongoing follow-up, contributing to poorer outcomes.
Strengthening heart failure care
A range of initiatives rolled out under the NSW Health Leading Better Value Care Initiative aim to improve access to, and coordination of, heart failure care.
These include statewide clinical networks, integrated care programs and organisational models of care that strengthen care coordination across acute, primary and community settings. Services use structured approaches to service delivery (including integrated care frameworks and coordinated chronic disease management models, such as the 3Ci Model of Care) to support more consistent, person-centred care pathways across the system.
How this resource was developed
The NSW Heart Failure Standards build on the 2016 Clinical Service Framework for Chronic Heart Failure, to reflect the latest best practice. In 2025, the network established a Heart Failure Working Group to lead the update and refine the content into the current standards.
The group updated the standards to reflect current evidence, evolving models of care and emerging health system needs. We created a web‑based resource to improve accessibility, usability and navigation across care settings.
A multidisciplinary group of clinical and system experts guided the work, with oversight from the ACI Cardiac Network and the Chronic Cardiovascular Clinical Expert Reference Group. Stakeholders also provided ongoing feedback to ensure the standards are practical, consistent and suitable for statewide use, while remaining adaptable to future priorities.
Acknowledgements
The NSW Heart Failure Standards have been updated thanks to the support, advice and collaborative efforts of many people and organisations and, in particular, the clinicians and subject matter experts acknowledged below:
- Michelle Baird, Nurse Practitioner, Chronic and Complex Care, Dubbo Hospital, Western NSW Local Health District (WNSWLHD)
- Jacqui Carnell, Clinical Nurse Consultant, Community Cardiac Services and Community Chronic and Complex Care, Wyong Hospital, Central Coast Local Health District (CCLHD)
- Eileen Crowe, Clinical Nurse Consultant, Coronary Care Unit, Wollongong Hospital, Illawarra Shoalhaven Local Health District (ISLHD)
- Maura Farrell, Nurse Unit Manager, Cardiac Rehabilitation and Heart Failure, Royal North Shore Hospital, Northern Sydney Local Health District (NSLHD)
- Dr Gary Gan, Cardiologist, Blacktown Hospital, Western Sydney Local Health District (WSLHD)
- Elizabeth Goode, Heart Failure Clinical Nurse Consultant, Blacktown Hospital, Western Sydney Local Health District (WSLHD)
- Kelly Hanvey, Cardiac Supportive and Palliative Care Nurse Practitioner, Northern Sydney Local Health District (NSLHD)
- Devlin Higgins, Exercise Physiology Program Manager, St Vincent's Hospital Sydney, St Vincent's Health Network (SVHN)
- Dawn McIvor, Cardiology Clinical Nurse Consultant, John Hunter Hospital, Hunter New England Local Health District (HNELHD)
- Glenn Paull, Clinical Nurse Consultant, Cardiology, St George Hospital, South Eastern Sydney Local Health District (SESLHD)
- Kerry Porter, Nurse Practitioner and Acting Course Coordinator, School of Nursing and Midwifery, Charles Darwin University
- Karley Robinson, Transitional Nurse Practitioner, Shoalhaven Heart Failure Service, Illawarra Shoalhaven Local Health District (ISLHD)
- Julie Rutherford, Cardiology Clinical Nurse Consultant, Maitland Hospital, Hunter New England Local Health District (HNELHD)
- Emilia Serban, Heart Failure Nurse Practitioner, Community Cardiac Services and Community Chronic and Complex Care, Central Coast Local Health District (CCLHD)
- Dr Caitlin Sheehan, Head of Department and Staff Specialist, Palliative Medicine, South Eastern Sydney Local Health District (SESLHD)
- Maria Sheehan, Nurse Practitioner, Heart Failure, St Vincent's Hospital Sydney, St Vincent's Health Network (SVHN)
- Professor Andrew Sindone AM, Director, Heart Failure Unit, Concord Hospital; Head of Department of Cardiology, Ryde Hospital, Sydney Local Health District (SLHD)
- Professor Aaron Sverdlov, Cardiologist and Director, Heart Failure Service, Hunter New England Local Health District (HNELHD)
- Orla Ward, Heart Failure Clinical Nurse Specialist, Royal North Shore Hospital, Northern Sydney Local Health District (NSLHD)