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Heart failure - chronic - Management
When should I refer people with suspected chronic heart failure?

For people with suspected heart failure:

  • Refer urgently (within 2 weeks) for specialist assessment and echocardiography:
    • People who have had a previous myocardial infarction (MI).
    • People without a history of MI who have high levels of natriuretic peptide — B-type natriuretic peptide (BNP) level above 400 pg/mL (116 pmol/L) or N-terminal pro-B-type natriuretic peptide (NT-proBNP) level above 2000 pg/mL (236 pmol/L).
    • People with severe symptoms (if admission is not indicated).
    • Women who are pregnant.
  • Refer within 6 weeks:
    • People without a history of MI who have a BNP level between 100–400 pg/mL (29-116 pmol/L) or an NT-proBNP level between 400–2000 pg/mL (47–236 pmol/L).
  • If natriuretic peptide levels are normal (BNP level less than 100 pg/mL [29 pmol/L] or NT-proBNP less than 400 pg/mL [47 pmol/L]), a diagnosis of heart failure is unlikely. However, referral may still be needed if:
    • Clinical suspicion of heart failure persists and the person is obese or taking drugs which lower natriuretic peptide levels (diuretics, angiotensin-converting enzyme inhibitors, angiotensin-II receptor antagonists, beta-blockers, or aldosterone antagonists).
    • Another condition is suspected, which requires referral to a specialist.
  • If it is not possible to measure natriuretic peptide levels, refer if:
    • The electrocardiogram (ECG) is abnormal.
    • The ECG is normal, but there is still a strong suspicion of heart failure.

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