Heart Failure: Investigations and Monitoring

Scope

The commonest cause of heart failure in the UK is coronary artery disease, and many patients have had a myocardial infarction in the past. Therefore we recommend annual monitoring to assess cardiovascular risk factors and renal function.

Out of scope

BNP and NT-proBNP are both useful "rule in" tests for suspected heart failure, but not appropriate for monitoring heart failure in primary care.

Investigations

Annually

  • Blood - Renal, HbA1C, non-HDL cholesterol (non-fasting)

Routine monitoring of digoxin levels is not recommended. A digoxin concentration measured at least 6 hours after the last dose may be useful to confirm a clinical impression of toxicity or non-adherence. Toxicity may occur even when the concentration is within the 'therapeutic range.'

BNP and NT-proBNP are both useful "rule in" tests for suspected heart failure, but not appropriate for monitoring heart failure in primary care.

Supporting Information

Evidence

Chronic heart failure: Management of chronic heart failure in adults in primary and secondary care. NICE guidelines [CG108]. Published: August 2010

Lipid modification: cardiovascular risk assessment and the modification of blood lipids for the primary and secondary prevention of cardiovascular disease. NICE guideline [CG181]. Published: July 2014.

Pathway Group

This guideline has been signed off by the Pathology Optimisation Clinical Group on behalf of NEW Devon CCG

Publication date: June 2017

 

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