What criteria should I use to refer a patient with suspected heart failure to a cardiologist?

Referral to a cardiologist or specialist heart failure team for a patient with suspected heart failure is indicated based on several criteria, including urgency and specific clinical findings:

• Urgent Referral (within 2 weeks):
  • Suspected heart failure with an N-terminal pro-B-type natriuretic peptide (NT-proBNP) level above 2000 ng/L (236 pmol/L) for specialist assessment and transthoracic echocardiography ¹,².
  • Syncope or presyncope (unless clearly due to postural hypotension), particularly in people with reduced ejection fraction (HF-REF), as this may indicate ventricular tachycardia ¹,³.
  • Severe heart failure (New York Heart Association [NYHA] class IV) ¹,².
  • Heart failure that does not respond to treatment in primary care or can no longer be managed in the home setting ¹,².
• Routine Referral (within 6 weeks or for specialist assessment):
  • Suspected heart failure with an NT-proBNP level between 400 and 2000 ng/L (47–236 pmol/L) for specialist assessment and transthoracic echocardiography ¹,².
  • Heart failure resulting from valvular heart disease ¹,².
  • Left ventricular ejection fraction of 35% or less ¹.
  • Women with heart failure and reduced ejection fraction (HF-REF) who are planning a pregnancy for specialist pre-conceptual advice, or women who are pregnant for specialist management ¹.
  • Consider referral for a person with heart failure and a comorbidity such as chronic kidney disease or chronic obstructive pulmonary disease ¹.
  • If underlying heart disease is suspected from clinical assessment and/or ECG, or if extrasystoles are frequent or ventricular tachycardia (VT) is suspected ³.
  • History or physical symptoms of structural heart disease, heart failure, or hypertension ³.