Concierge 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.
Why patients choose us
- 01
A consultant cardiologist, not a generalist
A named heart-failure cardiologist — the person who prescribes and titrates the four pillars — plus the HF nurse who runs the follow-up.
- 02
Full four-pillar therapy, properly titrated
ARNI, beta-blocker, MRA and SGLT2 inhibitor built up to target dose over weeks, with the blood tests and BP checks in between.
- 03
Device and advanced options on the table
CRT, ICD, LVAD and transplant referral discussed at the right moment — not months late. We route to the right centre when it counts.
Indicative pricing
What private heart failure treatment costs in London.
Indicative ranges across our partner clinics. Send the details and we quote firm figures for the consultation, the tests and the ongoing titration clinic.
In short
A first HF-cardiology consultation with echo and NT-proBNP: £700–£1,300, plan in one week.
| Service | Indicative range | Typical duration | Result / stay |
|---|---|---|---|
| Cardiologist consultation (HF specialist) | £250–£450 | 45–60 min | Same visit |
| Echocardiogram (TTE) | £350–£650 | 30–45 min | 48 hours |
| NT-proBNP blood test | £90–£180 | 10 min | 24–48 hours |
| Cardiac MRI (cause work-up) | £950–£1,600 | 45–60 min | 3–5 days |
| HF nurse-led titration clinic (per visit) | £150–£280 | 30 min | Same visit |
| CRT / ICD implant (self-pay indicative) | £18,000–£32,000 | Day case | 1–2 nights |
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.
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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.
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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.
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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.
The journey
From enquiry to a fully titrated regimen — what happens, in order.
One named cardiologist and one HF specialist nurse from first message to target dose — including the follow-up echo.
Phase 1 · Before your clinic
Concierge, off-stage for you
Phase 2 · On the day
A morning at the clinic
Phase 3 · After
Titration and follow-up
- 01
Before
You tell us what is going on
A short, confidential form. Breathlessness, ankle swelling, previous echo or BNP, current tablets, whether you have had a hospital admission.
- 02
Before
We come back with a plan
Within one working day: which cardiologist, whether an echo or NT-proBNP is needed first, and an indicative cost for the pathway.
- 03
Before
Baseline tests are arranged
Echocardiogram, NT-proBNP, ECG, bloods (U&Es, iron, thyroid, HbA1c) and cardiac MRI where the cause is unclear.
- 04
On the day
First consultation and diagnosis
A full clinic review — LVEF, NYHA class, cause worked up (ischaemic, hypertensive, valvular, CM). The four-pillar plan is written up in front of you.
- 05
On the day
Medication started and up-titrated
Quadruple therapy started in the right order, at the right starting dose, with monitoring bloods booked at week 1–2 and again at 4 weeks.
- 06
After
HF-nurse-led follow-up
A specialist heart-failure nurse runs the titration clinic — target doses of ARNI, beta-blocker, MRA and SGLT2i reached over 8–12 weeks.
- 07
After
Device and advanced review
At 3–6 months a repeat echo. If LVEF stays ≤35% on optimal therapy we discuss CRT, ICD, or referral to an advanced HF centre.
Typical end-to-end: 1–2 weeks to diagnosis. Target-dose therapy: 8–12 weeks.
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.
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Breathlessness on exertion
New or worsening shortness of breath climbing stairs, walking uphill, or lying flat at night (orthopnoea, PND).
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Ankle and leg swelling
Pitting oedema of the ankles, calves or thighs — worse by the evening, better after a night in bed.
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Reduced LVEF on echo
A recent echocardiogram showing LVEF <40% (HFrEF), 41–49% (HFmrEF) or ≥50% with symptoms (HFpEF).
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Raised NT-proBNP
NT-proBNP >400 pg/mL warrants specialist echo per NICE NG106; >2000 pg/mL is an urgent 2-week referral.
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Recent decompensation admission
A hospital admission for fluid overload, IV diuretics or worsening HF — the highest-risk window for re-admission.
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Ischaemic or non-ischaemic cause
Previous MI, dilated cardiomyopathy, hypertensive heart disease, valvular disease, chemo/radiation, alcohol, sarcoid or peripartum.
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AF, arrhythmia or tachycardia-induced
Persistent AF with fast rates, frequent ectopy or tachycardia-induced cardiomyopathy driving reduced LVEF.
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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.
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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.
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HFpEF pathway
SGLT2 inhibitor first-line (dapagliflozin, empagliflozin), MRA where tolerated, loop diuretic for congestion, and aggressive treatment of BP, AF, obesity and diabetes.
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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.
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Loop diuretics for congestion
Furosemide or bumetanide titrated to a euvolaemic weight. Not disease-modifying — used for symptoms of fluid overload.
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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.
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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).
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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.
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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).
Our vetted London network
A small panel of HF cardiologists, we picked them.
Consultant heart-failure cardiologists across central London, working with band-7 HF specialist nurses and with routes into UK LVAD and transplant centres when they are needed.
Selection criteria
How we choose every cardiologist in our network.
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Consultant cardiologists with a declared heart-failure interest, not general cardiologists
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Band 7 HF specialist nurses running the titration and follow-up clinics
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Access to CRT/ICD implantation and to a UK LVAD/transplant centre when needed
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Aligned with NICE NG106 and ESC 2021/23 heart-failure guidelines
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.
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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.
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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.
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SGLT2i and euglycaemic DKA
Rare but real. Hold dapagliflozin/empagliflozin during acute illness, before surgery, and if you are unwell with vomiting or fasting.
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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.
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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.
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Beta-blocker up-titration is slow
Bisoprolol, carvedilol or nebivolol are doubled roughly every two weeks, never during a decompensation. Slow is deliberate.
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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.
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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.
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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 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.
- 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).
- 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.
- 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).
- 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
Heart failure treatment is usually well covered by UK health insurers — consultation, echo and cardiac MRI included. Device implantation is authorised case by case; we confirm cover before booking.
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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
Related treatments
Looking for something else?
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Heart transplant
When medical and device therapy no longer suffice.
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Heart valve surgery
Repair or replacement for valvular heart disease.
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Atrial fibrillation
Rhythm and rate control, anticoagulation, ablation.
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All tests and procedures
Every test and procedure we arrange.
Learn more