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Heart failure

  

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Suspected Heart Failure

Referral criteria for Heart Failure Clinic new patient

Inclusion:

All adults with suspected Heart Failure.

Exclusions:

Valvular Heart disease

Pregnancy/pre-pregnancy counselling (direct referral to Dr Adamson)

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

Established Heart Failure with known HFREF – refer through RSS to Integrated Community Heart Failure Team. Referrals that are sent directly will need to be send to: uhc-tr.heartfailurenursereferrals@nhs.net

Under current cardiology follow up – contact the same consultant

 

URGENCY*[1]

2 weeks

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

6 weeks

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

[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.

Please see links in the hight 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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