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. ¹
• 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. ¹
• Performing transthoracic echocardiography to assess cardiac structure and function, including left ventricular systolic and diastolic function, and to exclude significant valve disease. Echocardiography should be done by experienced operators using high-resolution equipment. ¹
• Performing an ECG to detect arrhythmias or other cardiac abnormalities that may contribute to symptoms. ¹,²
• Considering additional investigations to exclude alternative diagnoses or aggravating factors, such as chest X-ray, blood tests (renal, thyroid, liver function, full blood count, HbA1c), urinalysis, and spirometry. ¹
• Reviewing and excluding other disorders that may mimic heart failure symptoms. ¹

Summary: Diagnosis in primary care relies on clinical assessment, NT-proBNP measurement, ECG, and referral for echocardiography to confirm cardiac dysfunction and exclude other causes. Prompt referral based on NT-proBNP thresholds is essential for timely specialist assessment. ¹,²