Heart Failure
Introduction
The Heart Failure (HF) service (RCHT) provides a single point of access for primary care to access advice, rapid assessment and management plans for patients with symptoms of HF.
The service is staffed by a HF MDT comprising HF nurse specialists, cardiology consultants, community cardiac nurses, cardiac technicians and palliative care specialists who work collaboratively to provide the care recommended by NICE.
Referrals should be made via the eRS single point of access. They will be triaged within 2 working days and a decision will be made on the need for and timing of echocardiography and subsequent review by the most appropriate team member.
Community echocardiograms should not be requested to diagnose HF.
Please refer all suspected cases via the single point of access service.
For patients in East facing practices referring to UHP, please see following guidance:
Inclusion Criteria
- Patients with suspected HF and NT-proBNP >400pg/ml
- Patients with an incidental diagnosis of HF on an echocardiogram showing left ventricular ejection fraction (LVEF) <50% within the last 12 months.
- Patients with an established diagnosis of HF with uncontrolled/worsening symptoms and NT-proBNP >400pg/ml (this helps determine the aetiology of current symptoms and risk-stratify the urgency of review needed)
- Please only refer patients with NT-proBNP <400pg/ml if persistent signs or symptoms of HF despite exclusion and optimisation of anaemia, thyroid disease, respiratory/renal/liver disease, nutritional state (including iron, B12 and folate) and fluid retaining drugs (calcium channel blockers, NSAIDs, steroids, glitazones, etc).
Exclusion Criteria
- Patients who are currently under a named cardiologist who is actively involved in managing their care. Please contact the consultant directly.
- Patients who are already under the community cardiac teams. Please contact the community team directly. They will liaise with the cardiologist in complex cases.
- Patients <16 years of age. Please contact the paediatricians.
Requirements for Referral
Recent ECG
Blood tests (within 1 month) as per “Heart Failure (Adults): Investigation” Order Set (purple top and yellow top), which includes;
Base line tests:
NT-ProBNP (unless echocardiogram within 12 months shows LVEF <50%)
FBC, UE, Albumin ,TSH (FT4)
Second line test only if BNP >400 (existing results may be re-reported if within 3 months if yellow tube not sent with NT-ProBNP)
Iron Saturation, Ferritin and Hba1c
Service Outcomes
GPs may be emailed with advice by a member of the service
Patients with NT-proBNP measurement >2,000pg/ml will be triaged for a 2-week echo + specialist review pathway.
Patients with NT-proBNP measurement between 400 and 2,000pg/ml will be triaged for a 6-week echo +/- specialist review pathway.
Patients with NT-proBNP <400pg/ml will be considered on a case-by-case basis if it can be demonstrated that other common causes for the patients’ symptoms have been excluded/optimised.
Date reviewed 11/10/2021
Next review due 11/10/2022
Contributors:
Dr Louise Melley – Assistant Specialist Cardiology RCHT
Dr B Wesson, GP and Kernow RMS Cardiology Guideline lead