Heart Failure
Heart Failure Referral.
NT-pro BNP testing is mandatory for all referrals with suspected Heart Failure (previous exclusions such as previous MI or AF no longer apply). Referrals without a NT-proBNP will be returned to the referrer.
- NT-proBNP under 400 pg/ml - heart failure unlikely. Consider alternative diagnosis. Discuss with specialist if ongoing concerns
- Patients with suspected heart failure and NT-proBNP 400 - 2000 pg/ml should be assessed in primary care and managed according to the BNSSG Primary Care Heart Failure Treatment Guideline (unless already under follow-up or known to secondary care Cardiology).
Depending on the result of the echocardiogram, some patients can be managed in primary care if the GP is confident in managing their treatment and titration of medication. If referral is necessary or GP would like their patient to be reviewed by a cardiologist then please refer to the Heart Failure Clinic in secondary care via eRS (please refer to the trust where the echo was performed) or consider Cardiology Advice and Guidance.
Prior to referral the following must be done: Cardiac examination (BP/pulse) - mandatory, NT-pro BNP - mandatory, U&E - mandatory, FBC, TFTs, LFTs, HbA1c & lipids - recommended, Echocardiogram - request on ICE at your local hospital trust, ECG - recommended to exclude arrhythmias, CXR - recommended to exclude other pathology.#
- Patients with suspected heart failure and NT-pro BNP >2000 pg/ml should be referred urgently to the BNSSG Community Heart Failure Clinic. (unless already under follow-up or known to secondary care Cardiology*)
Referrals must be made by email using the Sirona Community Heart Failure referral form (the form available as an EMIS document and will pre-populate) to sirona.heartfailureservice@nhs.net
- Patients will be seen in a one-stop, echo & consultant led diagnostic clinic in the community.
- A comprehensive management plan will be formulated, and any follow-up investigations will be arranged directly with secondary care.
- The outcome of the review will be communicated to primary care/patient via EMIS and by letter.
Advice and Guidance
Contact Sirona Heart Failure team on: 01179 617153 for advice 1-5pm Monday-Friday excluding bank holidays. The team has created a top-tips document for clinicians managing heart failure patients. This contains advice to consider before contacting the team, and details on managing patients with common issues such as; increased breathlessness, signs of fluid overload, abnormal renal function and hypertension.
The cardiologists at UHBW and NBT both offer Cardiology Advice and Guidance via eReferral. These services should be utilised where advice is required on the management of a patient that may avoid the need for referral. It should not be used where immediate advice is required; in which case the on-call teams should be contacted in the usual way.
Red Flags
Acute Heart Failure
If there is a rapid onset or worsening of heart failure symptoms (increasing breathlessness, fatigue, ankle /abdominal swelling or rapid weight gain) or other signs of cardiac decompensation (chest pain, arrhythmias, pre-syncope or syncope) consider emergency admission or same day discussion with on-call cardiology team within secondary care.
Useful Links
Remedy BNSSG guideline
CKS/NICE Guidelines
Information for patients
- https://www.nhs.uk/conditions/heart-failure/
- https://www.bhf.org.uk/informationsupport/conditions/heart-failure
- Support Guides | Pumping Marvellous - includes patient guides to medication