Diagnosis

In primary care, if the patient’s signs and symptoms are suggestive of heart failure, the GP clinical team should request a blood test for natriuretic peptide (usually NT-pro BNP). This is released when the heart muscle is stretched. 

If the level is raised this does not confirm a diagnosis of heart failure but it remains a differential diagnosis and the patient should be referred for an ultrasound scan of the heart and specialist review. Since extremely elevated levels of NT-pro BNP carry a poor prognosis, patients are triaged for assessment depending on what the levels are.

Echocardiogram

An echocardiogram is the gold standard tool for diagnosing and assessing heart failure. The results of this ultrasound scan will give a detailed assessment of the dimensions of the heart’s chambers, assess valvular function, and determine if systolic or diastolic dysfunction is present. 

Importantly, it is used to estimate the ejection fraction (the proportion of blood ejected from the heart with each heartbeat), which will determine both diagnosis and treatment pathway. The ejection fraction (EF) of a normal heart is 50-70 per cent. It is sub-divided into:

• Heart Failure with Reduced Ejection Fraction (HFrEF)
• Heart Failure with Mildly Reduced Ejection Fraction (HFmrEF)
• Heart Failure with Preserved Ejection Fraction (HFpEF).