What are the key diagnostic criteria for chronic heart failure in primary care settings?

Key diagnostic criteria for chronic heart failure in primary care settings include:

• Taking a careful and detailed history and performing a clinical examination to identify symptoms and signs suggestive of heart failure, such as breathlessness, fatigue, oedema, raised jugular venous pressure, and lung crepitations.
• Measuring N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels in people with suspected heart failure to aid diagnosis. An NT-proBNP level below 400 ng/litre (47 pmol/litre) makes heart failure less likely, while levels between 400 and 2,000 ng/litre warrant specialist assessment within 6 weeks, and levels above 2,000 ng/litre require urgent specialist assessment within 2 weeks.
• Performing transthoracic echocardiography to assess cardiac structure and function, including left ventricular systolic and diastolic function, and to exclude significant valve disease.
• Conducting an ECG to detect arrhythmias or other cardiac abnormalities that may contribute to symptoms.
• Ordering additional tests as appropriate to exclude alternative diagnoses or identify aggravating factors, including chest X-ray, renal function, thyroid function, liver function, lipid profile, HbA1c, full blood count, urinalysis, and lung function tests.
• Considering the impact of factors that may affect natriuretic peptide levels, such as obesity, ethnicity, and medications (e.g., diuretics, ACE inhibitors, beta-blockers).
• Excluding other disorders that may mimic heart failure symptoms before confirming the diagnosis.

These steps ensure a comprehensive approach to diagnosing chronic heart failure in primary care, facilitating timely referral and management.

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