Heart failure is a complex disorder that affects patients and their carers in many ways. Recommendations for improving the quality of care for people with heart failure are set out in the government’s National Sen/ice Framework for Coronary Heart Disease (Department of Health (DH) 2000a) and in the guideline commissioned by the National Institute for Clinical Excellence (NICE 2003a), which describes best practice for the management of patients with heart failure. This article discusses the role of the district nurse in meeting the challenges of the NICE guideline, and suggests that district nurses are better placed than other health professionals in primary care to have a central role in delivering such care. The contribution of district nurses to the management of patients with chronic diseases and those who are terminally ill at home is also discussed. The impact of The NHS Cancer Plan (DH 2000b) on the care of cancer patients in primary care is examined briefly to ascertain whether the NICE guideline is likely to have a similar impact on the scope and capacity of district nursing.