- Where heart failure is suspected perform clinical examination including ECG, chest x-ray, and FBC, U&E, LFT, glucose, TFT, +/- NTproBNP:
- If normal resting ECG without other clinical features suggestive of heart failure NTproBNP testing is not recommended.
- If LBBB or significant murmur is present request ECHO directly with ICE without need for BNP.
- If patient known to Cardiology department or echo within last 2 years please seek advice before requesting NT proBNP.
- NT pro BNP results should be treated with caution in the presence of co-morbidity, advanced age - see notes below re interpretation.
- Note that NTproBNP is now requested via ICE directly (no longer through transthoracic echo request algorithm).
After NTproBNP consider need for ECHO referral:
- If NTproBNP is less than 400ng/l - heart failure diagnosis unlikely - if normal ECG and no significant murmur ECHO not indicated.
- If NTproBNP 400-2000ng/L - consider heart failure as diagnosis, GP request ECHO via ICE, urgency dependent on clinical evaluation.
- If NTproBNP >2000ng/L - in absence of other causes heart failure likely, GP request URGENT ECHO via ICE if appropriate, based on clinical evaluation.
Following ECHO:
Once patient has had ECHO, patient will be triaged directly by heart failure cardiologist to either clinic or advice depending on the result.