Heart Failure

Heart Failure Diagnostic Referral Pathway

This pathway has been introduced throughout NHS Lothian to support the diagnosis of heart failure. Please follow the link below to the Heart Failure Diagnostic Referral Pathway flowchart which contains the key information, and also read the “Who to Refer” section below, which details referral criteria.

Follow link for Heart Failure Diagnosis Flowchart

Once referred, patients will be triaged to one of two pathways by the heart failure team:

• Heart Failure clinic review

• NT-pro-BNP blood test

Some patients may not be deemed suitable for either of these pathways and may instead be triaged to the General Cardiology outpatient clinic.

Blood tests

When referring your patient, please send bloods according to the Heart Failure Diagnosis order set which can be found on ICE/GPOC. If bloods are not received at the laboratory within two-weeks of the date of referral, the referral will be declined and the GP advised appropriately.

Blood results will be acted on by the Heart Failure team and will be returned to the GP for information only. NT-proBNP testing will only be performed if the patient is triaged to this arm of the clinic.

If the NT-proBNP level is above the diagnostic threshold and the clinical history is consistent with heart failure, then the patient will be seen at the Heart Failure Diagnosis clinic.

If the test result is below the threshold then a letter will be written to the GP with a clinical comment and advice only with no clinic arrangement planned.

NB: Results containing very high levels will be phoned directly to the heart failure team.

Who to refer:

Inclusion criteria

Any patient who meets all referral criteria can be referred via this pathway:

• Exertional or nocturnal dyspnoea: new-onset or major worsening
• No echo or cardiology review (for dyspnoea) within last 12 months
• No history of complex coronary, valvular, arrhythmic or congenital heart disease and not currently under long term supervision by a Cardiology Consultant.

How to refer:

• Please refer via electronic referral using SCI gateway select RIE > Cardiology > Heart Failure clinic > LI heart failure

Please note: this option is only available via the RIE Cardiology drop down menu but the service is available to all patients across Lothian.

• Send bloods according to the heart failure orderset on ICE/GPOC.

Please see Community Heart Failure Nurse Service for further advice.

Healthcare Professional Resources

Lothian Heart Failure Diagnosis Flowchart

SIGN Guideline 147: http://www.sign.ac.uk/guidelines/fulltext/147/index.html

Heart Failure Hub Scotland: www.heartfailurehubscotland.co.uk

Chronic Heart Failure NICE guideline: nice.org.uk/guidance/Cg108

ESC guidelines on acute and chronic heart failure: https://www.escardio.org/Guidelines/Clinical-PracticeGuidelines/Acute-and-Chronic-Heart-Failure

British Society of Heart Failure: www.bsh.org.uk

Scottish Heart Failure Nurse Forum: www.shfnf.co.uk

IMProved Anticipatory Care Team

Fit for Health

Patient Resources

Heart Failure charity: www.pumpingmarvellous.org

Chest Heart and Stroke Scotland – Patient Information Leaflets (PILs) including Traffic Lights self care guide, Heart Failure patient forums and newsletters, advice line and support for patients: http://www.chss.org.uk/heart/

European heart failure website: www.heartfailurematters.org

Cardiomyopathy Association: www.cardiomyopathy.org

British Heart Foundation: www.bhf.org.uk