Download New-‐onset Heart Failure – diagnosis and iniºal management

Exclusion to BNP tes4ng •  Previous diagnosis of Heart Failure New-­‐onset Heart Failure – diagnosis and ini4al management Pa#ent seen by GP – new onset symptoms (i.e., SOB, oedema, fa#gue, PND, orthopnoea) Take detailed history and examina#on Heart Failure suspected •  AWend hospital -­‐  Bloods FBC, U&E, BNP -­‐  CXR •  ECG by GP if available •  Aim for bloods and CXR within 5 working days BNP >400 BNP between 100 and 400 BNP <100 Urgent Direct access Echo Direct access Echo Normal or grade 1 diastolic dysfunc#on Discharged back to referrer •  Reassurance no HF •  Ix other possible causes of symptoms (+/-­‐ raised BNP) •  Lifestyle advice •  Manage risk factors GP care •  Mx plan from cardiology (with flag to GP if appropriate for proac#ve care) Abnormal Echo Cardiology referral if clinically appropriate (consider urgent referral if BNP>400 +/-­‐ severe abnormality on echo) Rou4ne Referral to Cardiology •  NICE recommends to be seen within six weeks •  follow up appointments as required •  Use of ‘Ultralinq’ to access echo result Or GP management of pa#ent Urgent Referral to Cardiology •  NICE recommends to be seen within 2 weeks •  Use of ‘Ultralinq’ to access echo result CCG Guideline April 2015 Poten4al causes of elevated brain natriure4c pep4de levels Cardiac Heart failure Diastolic dysfunc#on Acute coronary syndromes Hypertension with lea ventricular hypertrophy Valvular heart disease (aor#c stenosis, mitral valve regurgita#on) Atrial fibrilla#on Non-­‐cardiac Acute pulmonary embolism Pulmonary hypertension (primary or secondary) Sepsis (possibly due to #ssue hypoxia or secondary myocardial depression) Chronic obstruc#ve pulmonary disease with cor pulmonale or respiratory failure Hyperthyroidism Acute or chronic kidney injury Please advise pa4ents of the following 4mes to aNend the relevant hospital pathology department for their blood test: Worthing Hospital: Monday: 9.00am-­‐4.45pm Tuesday: 2.00pm-­‐4.45pm Wednesday: 9.00am-­‐4.45pm Thursday: 2.00pm-­‐4.45pm Friday: 9.00am-­‐4.45pm Southlands Hospital: Monday – Friday: 9.00am-­‐1.00pm St Richard’s Hospital: Monday – Friday; 9.00pm-­‐4.45pm