Nov 11 • General discussion
💓 Heart Failure: When to Refer. How to Treat. Not Everything Is an Emergency The CKS Edition
Heart failure can be one of those grey areas where urgency, management, and referral thresholds blur between primary and secondary care. The good news? Not every patient with heart failure needs an emergency admission and with the right knowledge, we can make confident, safe, and evidence-based decisions.
💡 Key reminders from NICE CKS:
Suspected heart failure?
Start with BNP/NT-proBNP testing.
If NT-proBNP >2000 ng/L, refer for specialist assessment and echo within 2 weeks.
If 400–2000 ng/L, refer within 6 weeks.
Confirmed heart failure (HFrEF):
Initiate ACE inhibitor (or ARNI if appropriate) and beta-blocker licensed for heart failure.
Consider mineralocorticoid receptor antagonists (e.g., spironolactone) and SGLT2 inhibitors (e.g. dapagliflozin) for additional benefit.
HFpEF management:
Focus on treating comorbidities (hypertension, diabetes, AF, obesity).
Diuretics for symptom control, but avoid over-diuresis.
🚑 When is it an emergency?
Acute pulmonary oedema
Hypotension, syncope, or worsening renal function
Severe breathlessness at rest or new hypoxia
If not acutely unwell, optimise therapy, monitor, and coordinate follow-up with early community and cardiology input makes all the difference.
🫀 Takeaway:
Primary and secondary care both play vital roles in preventing decompensation and improving quality of life. Empowering ourselves with CKS guidance means fewer unnecessary admissions and better long-term outcomes.
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💓 Heart Failure: When to Refer. How to Treat. Not Everything Is an Emergency The CKS Edition
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