BACKGROUND: The SARS-CoV-2 Coronavirus Disease (COVID-19) resulted in unprecedented societal and healthcare provision change that has been implemented at pace. Little is known about the indirect impacts of these changes and what the future effects may be. AIM: To explore patients' and clinicians' experiences of managing heart failure (HF) during the COVID-19 pandemic. DESIGN & SETTING: Qualitative study in three regions of the UK: Cambridgeshire, Greater Manchester and the West Midlands. METHOD: Semi-structured interviews (n=30) were conducted with older adults with established HF and healthcare providers from primary and secondary health services involved in their care. Interviews were analysed thematically. RESULTS: Compliance with the government guidance 'Stay home, Protect the NHS, Save Lives' during the COVID-19 pandemic and perceptions relating to risk from COVID-19 and underlying morbidity, drove 'being careful' behaviours and organisational changes. Enacting behavioural change and implementing organisational change resulted in opportunities and challenges for health and healthcare practice. CONCLUSION: Perception of risk led to significant behavioural and organisational change during the pandemic. Some changes described by both patients and clinicians, such as enhanced relationships and self-monitoring, present as opportunities and consideration should be given as to how to maintain or develop these. Equally, indirect impacts of COVID-19 and the associated lockdown such as disengagement and withdrawal, and the fallout from reluctance to access health services, should be acknowledged and interventions to address these challenges are needed.