Patients attending cardiology clinics, particularly those with chronic heart failure (CHF), frequently have co-morbidities and attend other hospital medical clinics. We examined the case notes of 162 patients attending two cardiology clinics. Many patients’ notes extended to more than one volume (20%). Patients with CHF were more likely to require rubber bands to maintain control of their notes than other cardiac patients. Despite efforts to move to a paperless record keeping system, rubber bands still play a major role in the NHS.