What are the key indications for referring a patient for echocardiography in primary care?

Key indications for referring a patient for echocardiography in primary care include:

• Adults presenting with a heart murmur where valve disease is suspected based on the murmur's characteristics, family history, age (especially over 75 years), or relevant medical history such as atrial fibrillation should be considered for echocardiography.
• If the patient with a murmur also has signs (e.g., peripheral oedema) or symptoms (e.g., angina, breathlessness) or an abnormal ECG, an echocardiogram should be offered.
• Urgent referral (within 2 weeks) for specialist assessment including echocardiography is indicated for adults with a systolic murmur and exertional syncope, or those with severe symptoms (angina or breathlessness on minimal exertion or at rest) suspected to be related to valvular heart disease.
• In suspected heart failure, measurement of NT-proBNP guides referral: levels above 2000 ng/L warrant urgent echocardiography and specialist assessment within 2 weeks, while levels between 400 and 2000 ng/L require assessment within 6 weeks.
• Adults with suspected heart failure and relevant symptoms should be referred for echocardiography to confirm diagnosis and guide management.
• Referral for echocardiography is also appropriate in patients with new or unexplained breathlessness, especially if accompanied by a murmur or other clinical signs suggestive of cardiac pathology.

These recommendations integrate the NICE guideline NG208 on heart valve disease and NG106 on chronic heart failure, which emphasize the importance of clinical features, natriuretic peptide levels, and symptom severity in guiding echocardiography referral in primary care ¹,².