Rapid Access Heart Failure Clinic
Please only use this pathway for referral of patients with a suspected new diagnosis of heart failure and a raised NTproBNP.
For patients with known heart failure with assessment in last 12 months, please optimise as per Dorset Heart Failure Pathway or refer to community HFSN team at dhc.dorset.heartfailure@nhs.net
To discuss your patient in the Heart Failure MDT instead, please email heartfailuredch@dchft.nhs.uk
For all patients with suspected heart failure who have signs of fluid congestion please consider starting treatment with a loop diuretic immediately.
NTproBNP is very sensitive but not very specific-i.e. identifies possible heart failure but does not confirm a diagnosis. Other causes of raised NTproBNP include AF, severe lung disease, age>70, and renal disease.
For patients with uncontrolled AF and no overt fluid overload (raised JVP, oedema) please consider rate control before checking NTproBNP. If the patient remains symptomatic with possible heart failure after rate control, then check NTproBNP and refer as usual. If minimally symptomatic at that stage, consider community echo and/or general cardiology referral. If new onset AF without heart failure, please refer to Rapid Access AF Clinic.
Please do not use this pathway for:
- Patients under active cardiology follow-up (refer back to usual consultant)
- Access to the heart failure nurses (refer directly to the community teams for patients with known heart failure)
- Patients who cannot attend hospital appointments
- Patients with severe competing comorbidity or frailty such that further investigation and specialist management of their heart failure are unlikely to improve quality of life or other outcomes (please consider frailty/matron service).