Gloucestershire Heart Failure Service Diagnostic/Referral Pathway


Gloucestershire Heart Failure Service Referral Form can be downloaded here.

Completed forms should be emailed to

NT (BNP) test requesting guidance

The BNP (NT) assay has now been introduced at Gloucestershire Hospitals NHS Foundation Trust to support the Gloucestershire Heart Failure Service (GHFS) suspected heart failure pathway. The following will help you understand the test and when and how to request appropriately.

Brain Natriuretic Peptide (BNP) is a hormone released by the heart when the ventricles are stretched e.g. by fluid overload. The hormone then causes fluid and sodium loss in the urine and mild vasodilation. In heart failure BNP levels are raised in keeping with the severity of heart failure. If BNP is below the threshold (<400) this makes heart failure very unlikely. However, if patient has signs and symptoms of heart failure, then GP should discuss with the Community Heart Failure Service.

The NICE guideline NG106 recommends that NT (BNP) is measured in patients with suspected heart failure. NT(BNP) testing will not be indicated however when there is:

  • A previous confirmed diagnosis of heart failure due to left ventricular systolic dysfunction

Patients with atrial fibrillation and symptoms and signs of heart failure should prompt referral to the GHFS for consideration for echocardiogram (using GHFS referral form)

Patients with a previous confirmed diagnosis of left ventricular systolic dysfunction may be referred directly to the GHFS for further management.

Left ventricular hypertrophy, right ventricular overload, ischaemia, tachycardia, hypoxaemia, pulmonary embolism, sepsis, COPD, diabetes, liver cirrhosis, more than 70 years old and eGFR less than 60ml/min may increase NT (BNP).

Obesity, diuretics, ACE inhibitors, beta blockers, angiotension receptor antagonists and aldosterone antagonists may reduce levels although it is felt unlikely to impact on screening but should be factored into clinical judgement when interpreting test results.

NT (BNP) is analysed by Clinical Biochemistry at Gloucestershire Hospitals. The sample should be collected into a gold top SST tube and sent to the laboratory on the day of collection. Requests should be made electronically via the ICE system by searching 'BNP' on 'NT-proBNP' or found in Other Pathology, Chem M-Z menu- NT-proBNP.

Patients with raised NT (BNP) levels (as below) should be referred to the Gloucestershire Heart Failure Service.


Heart failure service - GHC

Gloucestershire Care Services countywide community specialist team comprises specialist nurses, GPSIs and a cardiac physiologist. We offer echocardiography for patients with suspected heart failure . Our Specialist nurses and GPSIs work with patients to implement treatment and management plans.

Please ensure all information requested on the referral form is provided to avoid delays in our triage of your referral.

For patients with known heart failure, including re-referral of patients who have become unstable or are reaching end of life please contact the Heart Failure Service directly by letter giving detail of diagnosis, medical history and current medications.

For suspected heart failure:
Please refer to the Gloucestershire Heart Failure Service Diagnostic /Referral Pathway and carry out NTproBNP testing if appropriate
Complete the referral form and email to:
Please ensure all information requested on the referral form is provided to avoid delays in our triage of your referral

For management of patients with known heart failure:
Please contact the Service directly by letter giving detail of diagnosis (confirmed left ventricular systolic dysfunction), medical history and current medications.  Email referral letter to:

If you wish to discuss a referral please contact us and speak to one of our specialist nurses:
Tel: 0300 421 1212 option 1

Gloucestershire Heart Failure Service
Gloucestershire Health and Care NHS Foundation Trust
Southgate Moorings
2 Kimbrose Way

Advice and Guidance Service

Electronic consultant level Advice & Guidance can be obtained from GHNHSFT using the NHS e-Referral Service (formerly Choose & Book) within a range of specialties. Please view the resource for further information.

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