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Cardiology · London

Private heart failure treatment in London, by a consultant cardiologist.

Full guideline-directed four-pillar therapy for HFrEF, an SGLT2i-led pathway for HFpEF, and device or advanced options when they are needed - delivered by a named cardiologist and an HF specialist nurse, aligned with NICE NG106.

A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Indicative pricing

What private heart failure treatment costs in London.

Indicative ranges across UK private providers.

In short

A first HF-cardiology consultation with echo and NT-proBNP: £700–£1,300, plan in one week.

Service Indicative range
Cardiologist consultation (HF specialist) £250–£450
Echocardiogram (TTE) £350–£650
NT-proBNP blood test £90–£180
Cardiac MRI (cause work-up) £950–£1,600
HF nurse-led titration clinic (per visit) £150–£280
CRT / ICD implant (self-pay indicative) £18,000–£32,000

Prices vary by clinic, by which cardiologist takes the case, by whether an MRI or angiogram is added, and by how many titration visits the HF nurse needs to reach target doses. Devices are almost always insurer or NHS funded - self-pay quotes are indicative.

The problem

The right diagnosis, the four pillars, and someone who titrates them.

A large fraction of UK patients with HFrEF are still not on all four pillars at target dose - because titration is slow, needs blood tests, and needs someone to own it. That is the gap we close.

  • Not sure of the type?

    HFrEF, HFmrEF and HFpEF are treated differently. A proper echo and cause work-up decides the plan - and whether SGLT2i-led therapy is enough.

  • On tablets but no better?

    Nearly always the doses are sub-target. We rebuild the regimen and up-titrate in a nurse-led clinic over 8–12 weeks.

  • Wondering about a device?

    CRT, ICD, LVAD and transplant referral are all considered when LVEF stays low despite optimal therapy - at the right moment, not later.

When it helps

When formal heart failure treatment is the right step.

The presentations we see most, plus the one red flag that means an emergency rather than a clinic appointment.

  • Breathlessness on exertion

    New or worsening shortness of breath climbing stairs, walking uphill, or lying flat at night (orthopnoea, PND).

  • Ankle and leg swelling

    Pitting oedema of the ankles, calves or thighs - worse by the evening, better after a night in bed.

  • Reduced LVEF on echo

    A recent echocardiogram showing LVEF <40% (HFrEF), 41–49% (HFmrEF) or ≥50% with symptoms (HFpEF).

  • Raised NT-proBNP

    NT-proBNP >400 pg/mL warrants specialist echo per NICE NG106; >2000 pg/mL is an urgent 2-week referral.

  • Recent decompensation admission

    A hospital admission for fluid overload, IV diuretics or worsening HF - the highest-risk window for re-admission.

  • Ischaemic or non-ischaemic cause

    Previous MI, dilated cardiomyopathy, hypertensive heart disease, valvular disease, chemo/radiation, alcohol, sarcoid or peripartum.

  • AF, arrhythmia or tachycardia-induced

    Persistent AF with fast rates, frequent ectopy or tachycardia-induced cardiomyopathy driving reduced LVEF.

  • Red flag: acute decompensation

    Severe breathlessness at rest, frothy sputum, chest pain or syncope is an emergency - 999 or A&E, not a clinic booking.

Treatment options

The pillars, the add-ons, the devices, and beyond.

What each option actually does - and where it sits in a NICE NG106 / ESC 2021/23 pathway.

  • HFrEF quadruple therapy

    The four pillars - ARNI (sacubitril/valsartan), beta-blocker, MRA and SGLT2 inhibitor - started together and titrated to target dose over 8–12 weeks.

  • HFpEF pathway

    SGLT2 inhibitor first-line (dapagliflozin, empagliflozin), MRA where tolerated, loop diuretic for congestion, and aggressive treatment of BP, AF, obesity and diabetes.

  • HFmrEF pathway

    A middle-ground group. SGLT2 inhibitor is now standard; the rest of the quadruple regimen is often used, guided by cause and tolerance.

  • Loop diuretics for congestion

    Furosemide or bumetanide titrated to a euvolaemic weight. Not disease-modifying - used for symptoms of fluid overload.

  • Add-on drugs (ivabradine, vericiguat, digoxin)

    Ivabradine for HR >70 in sinus rhythm on max BB; vericiguat after decompensation; hydralazine + nitrate for Black patients or ACE/ARB intolerance.

  • CRT and ICD

    Biventricular pacing for LVEF ≤35% with LBBB and QRS >130 ms; primary-prevention ICD for LVEF ≤35% on ≥3 months of optimal therapy (NICE TA314).

  • LVAD and transplant referral

    For advanced HF despite optimal therapy - mechanical circulatory support (HeartMate 3) as bridge or destination, or transplant assessment at a UK centre.

  • HF nurse clinic and cardiac rehab

    Specialist HF-nurse titration clinics, structured cardiac rehab for NYHA I–II (III–IV excluded), and self-management education (fluid, salt, weights).

Safety and self-management

What to expect while therapy is built up - honestly.

Heart failure medicines work best when they are up-titrated over weeks, with the right monitoring. Here is what patients need to know about the process - and about self-management at home.

  • Renal function and potassium checked

    ARNI, MRA and SGLT2i all move creatinine and potassium a little. Bloods at week 1–2 and 4 are non-negotiable, then at each dose change.

  • Low BP is common, usually manageable

    ARNI and beta-blocker often drop systolic BP into the 90s. As long as you feel well, that is expected - the target dose still matters more.

  • SGLT2i and euglycaemic DKA

    Rare but real. Hold dapagliflozin/empagliflozin during acute illness, before surgery, and if you are unwell with vomiting or fasting.

  • Weight monitoring at home

    A daily morning weight tells you about fluid overload before symptoms do. A gain of >2 kg in three days is a diuretic-dose conversation.

  • Fluid and salt - sensible, not extreme

    A 1.5–2 L/day fluid cap in advanced disease, and no added salt. Very tight fluid restriction is rarely helpful and often backfires.

  • Beta-blocker up-titration is slow

    Bisoprolol, carvedilol or nebivolol are doubled roughly every two weeks, never during a decompensation. Slow is deliberate.

  • Cardiac rehab helps - for the right class

    Structured rehab improves symptoms and outcomes in NYHA I–II. Class III–IV is usually excluded; a supervised programme is safer.

  • Vaccinate against flu, COVID and pneumococcus

    HF is a strong indication for annual flu and COVID boosters and one-off pneumococcal cover. Chest infection is a common trigger for admission.

  • Red flags

    Breathlessness at rest, orthopnoea worsening overnight, syncope, chest pain, or a >2 kg weight jump in 3 days - call the HF team or A&E the same day.

Reading your clinic letter

Your HF clinic letter in four parts. Read the last one first.

Whatever mix of tests and drugs is involved, a good cardiology clinic letter keeps to the same shape.

A UK consultant cardiologist reviewing a heart failure clinic letter

A quiet reminder

Cardiology language is precise and can read coldly - we translate it for you.

If you would like us to talk you through the letter before your next clinic, just ask.

  1. 01 Header

    Diagnosis, LVEF and NYHA class

    HFrEF, HFmrEF or HFpEF; latest LVEF from echo; NYHA class I–IV; suspected cause (ischaemic, dilated CM, hypertensive, valvular).

  2. 02 Technique

    Investigations and cause work-up

    Which tests were done - echo, NT-proBNP, ECG, bloods, angiogram, cardiac MRI - and what they showed about aetiology.

  3. 03 Findings

    Current medications and target doses

    The four pillars listed with current dose and target dose, plus loop diuretic, and any add-on (ivabradine, vericiguat, digoxin).

  4. 04 Impression

    Plan, titration schedule and review

    Read this first: which drug is being up-titrated next, when the next bloods and BP are due, and when the next echo and clinic review are booked.

Recognised by major UK insurers

BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

Heart failure treatment is usually well covered by UK health insurers - consultation, echo and cardiac MRI included.

Frequently asked

Everything we get asked about heart failure treatment.

Quick answers on the four pillars, HFpEF, NT-proBNP, devices and when a transplant conversation belongs.

  • What are the four pillars of heart failure treatment?

    For HFrEF (LVEF <40%), the guideline-directed regimen is an ARNI (sacubitril/valsartan) or ACE-inhibitor, a beta-blocker (bisoprolol, carvedilol or nebivolol), an MRA (spironolactone or eplerenone), and an SGLT2 inhibitor (dapagliflozin or empagliflozin). All four together - not one after the other - and titrated to target dose over 8–12 weeks.

  • What is the difference between HFrEF, HFmrEF and HFpEF?

    HFrEF is heart failure with a reduced left-ventricular ejection fraction below 40%. HFmrEF sits at 41–49% (mildly reduced). HFpEF is heart failure with preserved ejection fraction of 50% or higher, driven by stiffness rather than weak pumping. Treatment overlaps but is not identical.

  • Does treatment for HFpEF really exist now?

    Yes. SGLT2 inhibitors (dapagliflozin - NICE TA1055; empagliflozin) are the first disease-modifying drugs shown to help HFpEF, based on EMPEROR-Preserved and DELIVER. MRAs (spironolactone) and finerenone have a role too. Diuretics manage congestion, and treating BP, AF, weight, sleep apnoea and diabetes matters as much as any tablet.

  • What is NT-proBNP and when should mine be checked?

    NT-proBNP is a blood test that rises when the heart is under strain. NICE NG106 uses it as a triage tool: over 2000 pg/mL is an urgent 2-week echocardiogram; 400–2000 pg/mL is an echo within 6 weeks; under 400 makes heart failure unlikely.

  • Do I need a defibrillator (ICD) or CRT?

    CRT (biventricular pacing) is considered if your LVEF stays ≤35% with LBBB and QRS >130 ms despite ≥3 months of optimal medication. A primary-prevention ICD is offered if LVEF stays ≤35% (NYHA II–III) on optimal therapy, per NICE TA314. Neither decision is made until the tablets are at target dose.

  • Is a private cardiologist worth it if I already have an NHS team?

    Sometimes yes. Private care is often quicker for a first echo, a cause work-up cardiac MRI, or a second opinion on device therapy or LVAD/transplant referral. Ongoing HF nurse follow-up is often better delivered by an NHS community HF team - we help you decide which parts to run privately.

  • Can I still exercise with heart failure?

    Yes, and you should. Regular aerobic activity and cardiac rehab improve symptoms, quality of life and outcomes in NYHA I–II. Class III–IV needs a supervised programme. The right prescription is walking most days, building up gradually, not bed rest.

  • When does someone need an LVAD or heart transplant?

    Advanced heart failure that is not controlled by optimal medication, CRT/ICD and rehab. Options include a left-ventricular assist device (HeartMate 3) as a bridge to transplant or as destination therapy, and orthotopic heart transplantation. Referral is to one of six NHS-commissioned UK centres.

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