• heart failure

The initiatives described below have developed in a particular way, reflecting the local environment including its history, and recent clinical advances and imperatives in the field of heart failure. These initiatives are part of a much broader range of innovations, some of which are at an early stage in their development. Others have been in place for many years reflecting a longstanding local commitment to address the issues of consistency and continuity of optimal cardiovascular care, research and education, across primary, secondary and tertiary care domains in and around the Whittington Hospital, London (and more recently the Whittington University College London campus).

Only through an understanding of the local context will it be possible for others to assess the applicability of the described models to their own practice. The Whittington Hospital provides cardiovascular care for a local population of some 220–240,000 people for whom Camden and Islington, and Enfield and Haringey have historically been the main commissioners. The population characteristics shown for Camden and Islington in fig 1 illustrate the pronounced social divides within this health authority.¹ It is relevant that the predominance of the population served by the Whittington Hospital come from those areas with the two highest social deprivation quartile ratings, which reflect characteristics such as high levels of unemployment, various ethnic groupings with limited English, and an above average prevalence of mental illness. Similar demographics apply to many of those within Enfield and Haringey served by the Whittington Hospital. For this local population, social deprivation, a well described marker for adverse outcome from cardiovascular disease, has historically been compounded by an under provision of cardiovascular services including a low ratio of cardiologists to patient population,² inadequate access to diagnostic services, and long waits for both emergency and elective intervention. Furthermore there has been no local …