Treatment of heart failure is complex, requiring attention to diet, lifestyle, complex therapeutic regimens, device therapy, and sometimes surgery.1 Some clinical trials have demonstrated improved outcomes for patients with heart failure, in part, by selecting a relatively homogeneous, educated group of patients and ensuring that they are well informed and supervised. In clinical practice, patients are more heterogeneous, treatment is often more complex, and supervision less well resourced. Many patients have difficulty adopting complex care regimens and adherence to evidence-based regimens remains low, although this may be as much a failure of physicians to prescribe as of patients to adhere. Facilitating a more active role for patients in self-management of long-term medical conditions is not just a public relations exercise; it is an increasingly essential component of good clinical care.
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