Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
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. NICE NG106
- 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. NICE NG106
- 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. NICE NG106
- Performing an ECG to detect arrhythmias or other cardiac abnormalities that may contribute to symptoms. NICE NG106,NICE CKS
- 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. NICE NG106
- Reviewing and excluding other disorders that may mimic heart failure symptoms. NICE NG106
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. NICE NG106,NICE CKS