Heart Failure

Availability

North South North West Statewide

Pre-referral work-up

History

Direct referral to:

  • Heart Failure Clinic for complex and advanced heart failure
  • Nurse Practitioner for established heart failure patients
  • Patients with suspected heart failure should be referred to the general Cardiology Clinic

All referrals should comply to the Referral Standards and must include:

  • Details of relevant signs and symptoms
  • Details of all treatments offered and efficacy
  • Relevant previous medical history and co-morbidities
  • BP
  • Weight, Height & BMI
  • Recent fluctuations in weight indicative of cardiac dysfunction (if known)

Tests

  • FBE & iron studies
  • U&Es, Creatinine
  • TFTs
  • LFTs
  • CXR
  • ECG - if available - usually undertaken at the clinic
  • Consider Echocardiogram

Interim/GP management

To refer a patient with this condition, please see the Cardiology clinic page for the full referral process and templates.

Additional information which may assist triage:

  • Sleep study report if OSA suspected
  • Stress test report (if performed)
  • Investigations relevant to co-morbidities
  • Respiratory function tests if patient a smoker, has COPD or asthma
  • Echocardiogram report
  • BNP or NT-pro-BNP results (consider BNP for diagnostic dilemma ,provide old results if available)
  • History of smoking, alcohol intake and drug use (including recreational drugs)
  • Aboriginal or Torres Strait Islander or Maori/Pacific Islander / Refugee status (increased risk of acute rheumatic fever and rheumatic heart disease)
  • Iron studies

Interim management advice for heart failure can be found on the Health Pathways website.

For more information please see the Tasmanian Health Pathways website.

Emergency

Acute cardiac failure/APO

Urgent / category 1

Known heart failure with:

  • ongoing chest pain
  • increasing shortness of breath
  • oxygen saturation < 90%
  • signs of acute pulmonary oedema
  • haemodynamic instability:

- pre-syncope / syncope / severe dizziness

- altered level of consciousness

- heart rate > 120 beats per minute

- systolic BP < 90mmHg

  • significant pulmonary or pedal oedema
  • recent myocardial infarction (within 2 weeks)
  • pregnant patient
  • signs of myocarditis
  • signs of acute decompensated heart failure

Semi-urgent / category 2

  • Suspected or newly diagnosed heart failure
  • Heart failure patients with fluctuation in symptoms and at risk of acute exacerbation.

Routine / category 3

Established heart failure patients requiring review, ongoing management plans and education - these patients can be referred directly to the Heart Failure Nurse Practitioner

Red flags are clinical indicators of possible serious underlying conditions requiring further medical intervention. They may or may not indicate an emergency.

Heart Failure Nurse Practitioner contact details:
Sue Sanderson: Phone: (03) 6166 7398

Emergency:

Proceed to Emergency Department (ED). Please contact ED Medical Officer in Charge:
LGH ED – Phone: (03) 6777 6405  Fax: (03) 6777 5201
MCH ED – Phone: (03) 6478 5120  Fax: (03) 6441 5923
NWRH
ED – Phone: (03) 6493 6340  Fax: (03) 6464 1926
RHH ED - Phone: (03) 6166 6100  Fax: (03) 6173 0489

Urgent:

Urgent referrals should be accompanied by a phone call to the Consultant/Registrar to organise urgent review and the referral must be faxed.

We will endeavour to see these patients within one week, or sooner if clinically indicated.

Semi-urgent:

We will endeavour to see these patients within four weeks

Routine:

Next available appointment usually within eight weeks