Heart Failure Pathway Information and Contact Details

This detailed pathway outlines the diagnostic and management steps for suspected heart failure, including NTproBNP levels, exercise capacity assessment, blood tests, and medication initiation criteria. It also provides information on Virtual HF MDT consultations, specialist support, and contact details for Dr. Gareth Archer, Consultant Cardiologist and Heart Failure Lead at DBTH.

• Heart Failure
• NTproBNP
• Cardiology
• Management
• Virtual MDT

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Uploaded on Jul 02, 2024 | 1 Views

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1. GP Pathway Refer to cardiology Check NTproBNP Exercise capacity: Suspicion of heart failure If NTproBNP >400 NTproBNP ECG if AF suspected If NTproBNP > 2000 m/yrds/stairs/miles New onset SOB Bloods to include: Result: Refer to practice/PCN HF clinician to commence: Beta blocker*# Orthopnoea/PND (FBC, LFTs, Renal function, Thyroid function, HbA1c, Lipid profile, Iron studies including Ferritin & Transferrin saturation) (for very frail/immobile patients a symptom based approach likely to be more appropriate rather than referral) Oedema Fatigue likely due to HF Loop Diuretic* SGLT2i* #Prescribe beta blockers if no overt pulmonary oedema, brittle asthma (recurrent hospital admissions/ITU stay) and systolic BP >90systolic and HR >65bpm Discuss at Virtual HF MDT if concerned/advise needed Please email completed form with summary of diagnoses and medications to: dbth.racpdri@nhs.net * Prior to initiation exclude aortic stenosis on clinical examination, consider acute infection, PE and pericardial effusion as alternative diagnoses. *Empagliflozin or Dapagliflozin should be used. If already taking Canagliflozin this should be continued instead.

2. Practice Pharmacist/ PCN pharmacist Pathway Delay in cardiology review >2 weeks continue to titrate diuretics as needed Await echo and cardiology review Up titrate medications consider adding MRA and ACEi/ARB * NTproBNP falling Symptoms improving Expedite cardiology review / discuss at virtual HF MDT NTproBNP rising Arrange repeat NTproBNP and U&E in 1-2 week Other diagnoses excluded. Expedite cardiology referral/ discuss at virtual HF MDT Consider alternate diagnosis: CXR, ECG, PFTs, Ddimer, CRP where appropriate Symptoms deteriorating or NTproBNP rising Or Cr risen >50% Or K+ risen > 5.5 Discuss with GP/senior clinician *See guidance for up titration Specialist support/advice regarding initiation of SGLT2i: https://medicinesmanagement.doncasterccg.nhs.uk/wp- content/uploads/2023/07/HF-SGLT2-letter.pdf

3. Secondary Care pathway Follow up to remain under secondary care Yes Need for secondary care optimisation ARNi, Device etc Yes Discharge to HFSN who can work with to PCN pharmacist. Referred back to practice pharmacist/HFSN for optimisation of medications and monitoring Underlying aetiology identified and reversible causes addressed eg VHD No New diagnosis HFREF to be followed up in consultant led clinic Cardiology review Echo prior/1 stop shop Follow up to remain under secondary care No

4. Contact Details Dr Gareth Archer Virtual HF MDT every Thursday and Friday 12.45-13.15 from 1st February. Consultant Cardiologist and Heart Failure Lead DBTH garetharcher@nhs.net Secretaries: Doncaster DBTH.cardiosec@nhs.net 01302 642155/642156 https://teams.microsoft.com/l/meetup- join/19%3ameeting_NTNmYjYzMDctZDRlNC0 0MjYxLWI1ODMtMjZjNDQ2YjQ4Mjc2%40thre ad.v2/0?context=%7b%22Tid%22%3a%2237c 354b2-85b0-47f5-b222- 07b48d774ee3%22%2c%22Oid%22%3a%222f fb63e3-b0e7-43bf-85f9- 27a792641983%22%7d Bassetlaw D.Chester@nhs.net 01909 572775 Sophie Barton Virtual HF MDT Administrator sophie.barton6@nhs.net / 01302 642152 Dean Eggitt GP and Heart Failure Lead CEO Doncaster LMC The Oakwood Surgery deaneggitt@hotmail.com 01302 537611