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NHS Tayside

Who to refer

• New patients follow BNP pathway
• Existing patients with uncontrolled symptoms.
• Consider if normal BNP, other causes excluded but persistent clinical picture consistent with cardiac failure.
• Patients with pBNP 400-2,000 in whom there is significant clinical concern – this will allow cardiology to escalate echo priority where appropriate.
• Cardiology management of confirmed heart failure refer via SCI Gateway/Cardiology

Who not to refer

  • BNP is less than 400 ng/L, be aware that a diagnosis of heart failure is less likely. Consider other causes first. 
  • Murmurs - see murmur pathway
  • Rhythm disturbance - see palpitations/AF pathways.
  • Patients with BNP >2,000 who will be picked up urgently via the echo already (to avoid duplicate appointments being sent)

How to refer

  • For new diagnoses see BNP pathway. Patients are directly triaged to clinic or advice given depending on ECHO result. 
  • For cardiology management of confirmed heart failure refer via SCI Gateway/Cardiology.

Include baseline investigations:

  • ECG (looking for evidence of cardiac abnormality, rhythm disturbance, evidence chronic respiratory disease). 
  • BNP/ECHO results if available
  • FBC, U&E, LFT, TSH, Glucose, cholesterol
  • CXR to look for supportive evidence of cardiac failure or evidence of other causes. 

Alternative to Referral

  • Non-urgent advice via SCI Gateway/Advice referral. 
  • Murmur (use murmur pathway)
  • Known valvular heart disease.
  • In patients known to cardiology already please seek advice via SCI Gateway to named Cardiologist

Specialty Description

Direct access BNP testing and ECHO are available via ICE. After ECHO patients are directly triaged to clinic or advice depending on result. Clinics are run by a team of NHS Tayside Cardiologists and Specialist Nurses.

Useful resources

SIGN 147 Management of Chronic Cardiac Failure. Quick Reference Guide. 

NYHA Classification

NYHA I No symptoms and no limitation in normal physical activity
NYHA II Mild symptoms and slight limitation during ordinary activity. Comfortable at rest.
NYHA III Marked limitation in activity due to symptoms even during less than ordinary activity. Comfortable only at rest.
NYHA IV Severe limitations. Experiences symptoms even when at rest