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Heart Failure (Suspected and Established)

  

Suspected Heart Failure

 

New Patient Referral criteria Heart Failure Clinic

NB: If the echo is NORMAL the patient will not be assessed by a Consultant and will be referred back to the referring GP.

If currently under cardiology follow up – discuss with the same consultant

 

Inclusion criteria:

  • All adults with suspected Heart Failure.

 

Exclusion criteria:

  • Valvular Heart disease
  • Pregnancy/pre-pregnancy counselling (direct referral to Dr Adamson)

BNP <47pmol/I (< 400ng/I Heart Failure unlikely; consider other diagnosis)

 

 

Pre Referral Investigations / Findings

Required Desirable
NT-proBNP Peak flow or spirometry
Previous H/O MI: yes/no BP
CXR PULSE
ECG JVP
FBC, U&Es, TFTs, LIPIDS, GLUCOSE NYHA Class

 

URGENCY[1*] of Referral

2 Week Referral

NT- proBNP >236 pmol/I (>2,000ng/I) or previous MI

6 Week Referral

NT -proBNP 47-236 pmol/I (400-2,000ng/I

Email to Booking Centre

 uhcw.appointments@nhs.net

Refer via Choose & Book

Heart Failure (Low BNP)-Cardiology-University Hospital Coventry-RKB

[[1*]Urgency here refers to NICE guidance on Heart Failure rather than cancer Two Week Wait.

This is also on path links when NT-proBNP is reported.

Therefore NT-proBNP testing is mandatory prior to referral.

Established Heart Failure with known HFREF

Refer Integrated Community Heart Failure Team (Known Heart Failure-Integrated Heart Failure Team-UHC-RKB) via Referral Support Service

Patients with established HF and an up-to-date echo (last 12 months), reduced EF and been reviewed within the last 12 months by the HF service can be referred to: uhc-tr.heartfailurenursereferrals@nhs.net

 

Additional Information

Please see links in the right hand panel to:

Referral form for suspected heart failure

Referral criteria for local heart failure services

Causes of falsely positive and falsely negative BNP

Heart Failure Titration Schedule

  • Coventry Guidelines on Medical Therapy for Heart Failure (48 pages):
    • The index is on page 3
    • NYHA classification page 5
    • Loop diuretics pages 7-9
    • ACEi pages 12-15
    • ARBs page 16
    • Spironolactone pages 23 and 26.
    • Beta blockers – general information pages 19-22, shared care arrangements page 40, uptitration schedule pages 40-42.

Local arrangements are based on the NICE Guideline CG108 on chronic heart failure (please see link in right panel).

Heart Failure Rehabilitation Service for Coventry and Rugby

NICE guidance recommends an offer of a structured programme including monitoring, physical activity and psychological support to reduce mortality and hospitalisation

Heart Failure Rehabilitation Service provided in conjunction with Atrium (see also Pulmonary Rehabilitation) to ensure patients with HF are able to manage their condition and live life as full as possible

Services provided:

  • Initial nurse led assessment and education with gol setting
  • 12 week gym or group based exercises (twice per week)
  • Regular follow up with heart failure nurse with titration of HF medications as per NICE guidance
  • Nutritional & psychological support
  • Final exercise assessment with patient and carer
  • Help with transition to independent exercise

Referral criteria:

  • Referrals welcome for ALL diagnosed heart failure patients registered in Coventry or Rugby
  • Patient must consent to referral
  • Commitment to 12 week exercise programme
  • Clinically stable for 4 weeks (this may not mean that medications are optimised)
  • NYHA I, II, III and IV
  • LV systolic dysfunction underlies heart failure
  • Complete referral form

Exclusion criteria

  • Ensure the patient does not have a condition or device that would preclude an exercise-based rehabilitation programme ie
  • Uncontrolled ventricular response to atrial fibrillation, uncontrolled hypertension, and high-energy pacing devices set to be activated at rates likely to be achieved during exercise. (NICE 2010)

Coventry Referrals

Secure Email to: uhr-tr.coventryheartfailurerehab@nhs.net

Post to: Community Heart Failure Team, Rehabilitation Referral, Paybody Building, Stoney Stanton Road, Coventry CV1 4FS

Referral enquiries Coventry:

Community Heart Failure Service 0300 3032444

Atrium Health, Centre for Exercise & Health Unit, 1 Watch Close Coventry CV1 3LN  Tel: 024 76234570

Rugby Referrals

Secure Email to: uhc-tr.rugbycardiacrehabservice@nhs.net

Referral enquiries Rugby:

Rugby Cardiac rehabilitation Service 01788 663463

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