Primary Care

This section is intended for primary healthcare professionals only

This is Bob. He's been fighting heart failure for over ten years.

 


Please note that this section is not a comprehensive medical education resource. It aims to increase awareness of key points in the diagnosis and management of heart failure.

Fighting Failure has been developed to improve heart failure care across the UK. We aim to build awareness of heart failure and offer knowledge to both the public and healthcare professionals to show the impact of heart failure and inspire action. By identifying symptoms early and giving accurate diagnoses and optimal treatment, you can help to Fight Failure. #FightingFailure

The importance of early heart failure diagnosis

Heart failure care in the UK needs to see major improvements. It costs the NHS 2% of its entire budget1 and makes up 5% of all emergency medical admissions to hospitals.2

Patients who are diagnosed with the condition at a later stage, at the time they are admitted to hospital for example, can contribute to increased strains on time, budgets and resources. The presence of multiple co-morbidities in patients also places an additional burden on the NHS, as they require an integrated multi-disciplinary team to help manage the condition and provide optimal treatment.2,3

Ensuring patients are diagnosed correctly, offered the appropriate treatment early on and given the care they need means you can give them a better quality of life, reduce hospital admissions and overall reduce the strain on the NHS.

Heart failure shares multiple symptoms with other conditions, such as respiratory diseases, so it can be easy to overlook. However, you can offer any patient displaying heart failure symptoms and/or signs the NT-proBNP blood test. This can provide you with important information in addition to performing a clinical examination and other tests to aid diagnosis.2 Read more on the importance of the blood test below.

Don't miss heart failure symptoms

Heart failure shares several symptoms with other conditions, such as respiratory disease, so it can be easy to miss or overlook. This can lead to misdiagnosis or delayed diagnosis. The longer heart failure remains undiagnosed, the more damaging it is to the patient, which in turn may increase the burden on the NHS over the long term, so it’s important that heart failure is at the forefront of your mind when a patient presents symptoms.

+ The most common symptoms of heart failure are:4

  • Dyspnoea
  • Orthopnoea
  • Paroxysmal nocturnal dyspnoea (PND)
  • Reduced exercise tolerance
  • Fatigue
  • Bilateral ankle oedema

+ Other symptoms of heart failure can include (list not exhaustive):4

  • A nocturnal cough
  • Loss of appetite
  • Palpitations (a pounding, fluttering or irregular heartbeat)
  • Dizziness or fainting
  • Bloated feeling

+ The more specific signs of heart failure include:4

  • Elevated jugular venous pressure
  • Third heart sound (gallop rhythm)
  • Laterally displaced apical impulse
  • Hepatojugular reflux

+ Less specific signs of heart failure can include (list not exhaustive):

  • Weight gain (>2 kg/week)
  • Irregular pulse
  • Ascites

NT-proBNP

The NT-proBNP blood test is a crucial step in diagnosing a patient’s heart failure.

As per The National Institute for Health and Care Excellence (NICE) guidelines, every patient with suspected heart failure presenting in primary care should be offered an NT-proBNP test and, if indicated, be referred to a specialist to confirm the diagnosis and ensure appropriate follow-up care. Since NT-proBNP is a rule-out test, a referral may not be required if the levels are low.2

You should refer the patient for specialist assessment and transthoracic echocardiography according to their NT-proBNP results:2

  • Urgently within 2 weeks if above 2,000ng/litre (236 pmol/litre)
  • Within 6 weeks if between 400 and 2,000ng/litre (47 to 236 pmol/litre)6

The heart failure specialist multidisciplinary team (MDT) will confirm the diagnosis following further investigations such as an echocardiogram.

Listen to...

Dr Simon Williams of the British Society for Heart Failure explain the importance of NT-proBNP testing in patients presenting with symptoms of heart failure.

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Other tests to aid diagnosis

The relative non-specificity of heart failure symptoms and signs means that other tests may also be necessary to diagnose heart failure accurately.

Transthoracic echocardiography (or another cardiac imaging test) is essential to assess heart function and detect any abnormalities.

An ECG should also be performed to provide additional information. A normal ECG makes the diagnosis of heart failure unlikely.4

Other tests which may help you identify aggravating factors and/or alternative diagnoses include (but are not limited to):2

  • Chest X-ray
  • Baseline renal function [Urea and Electrolytes]
  • Thyroid function tests
  • Liver function tests
  • Lipid profile
  • Glycosylated haemoglobin (HbA1c)
  • Full blood count
  • Urinalysis
  • Peak flow or spirometry

Heart Failure Specialist Multidisciplinary Team (MDT)

The core specialist heart failure MDT should work in collaboration with the primary care team and should include: a lead physician with subspecialty training in heart failure, a specialist heart failure nurse and an HCP with expertise in specialist prescribing for heart failure.2

The MDT should:2

  • diagnose heart failure
  • give information to people newly diagnosed with heart failure
  • manage newly diagnosed, recently decompensated or advanced heart failure (NYHA [New York Heart Association] class III to IV)
  • optimise treatment
  • start new medicines that need specialist supervision
  • continue to manage heart failure after an interventional procedure such as implantation of a cardioverter defibrillator or cardiac resynchronisation device
  • manage heart failure that is not responding to treatment

Help your patients
track their symptoms

Use our Heart Failure Symptom Tracker and share it with your patients so they can keep a detailed record of their symptoms on a weekly/monthly basis.

 
Help us fight heart failure

Share what you’ve read today and together we can improve care for people living with heart failure across the UK.

I’m working to improve heart failure care in the UK. Together we can ensure every patient is diagnosed early and has access to a heart failure specialist.

#fightingfailure

   
 

Sunil talks about
Heart Failure

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Best Practice In
Heart Failure

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References

  1. All-Party Parliamentary Group on Heart Disease and British Heart Foundation. Focus on Heart Failure: 10 recommendations to improve care and transform lives. 2016. Available online at: www.bhf.org.uk/-/media/files/campaigning/appg-on-heart-disease-focus-on-heart-failure-report.pdf. Last accessed: February 2020.
  2. NICE. Chronic heart failure in adults: diagnosis and management. NG106. September 2018. Full guideline. Available online at: https://www.nice.org.uk/guidance/ng106/resources/chronic-heart-failure-in-adults-diagnosis-and-management-pdf-66141541311685. Last accessed: September 2020.
  3. Morton G., et al., Multidisciplinary team approach to heart failure management. Heart 2017;1–7.
  4. Ponikowsi et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. European Heart Journal (2016) 37, 2129–2200 doi:10.1093/eurheartj/ehw128

CVM20-E011g August 2020

Fighting Failure is a disease awareness campaign that has been sponsored and funded by Novartis Pharmaceuticals UK Ltd.

© 2020 Novartis Pharmaceuticals UK Ltd.

Novartis Pharmaceuticals UK Limited is a private limited liability company registered in England and Wales under number 119006 Registered office 2nd Floor, The WestWorks Building, White City Place, 195 Wood Lane, London, W12 7FQ.

Reporting side effects
Adverse events should be reported. Reporting forms and information can be found at https://yellowcard.mhra.gov.uk/ (UK).

CVM20-E011b August 2020