Heart failure service- GCS

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.

If you wish to discuss a referral please contact us and speak to one of our specialist nurses:

Tel : 0300 421 1212 option 1  Fax: 0300 421 1211

Gloucestershire Heart Service

Gloucestershire Care Services NHS Trust

Edward Jenner Court

1010 Pioneer Ave.,

Gloucester Business Park


Please refer to the guidance below prior to referring to the Service.

Exclusion Criteria

  1. Heart rate > 100bpm – please rate control before ECHO
  2. Known history of Cardiomyopathy
  3. Known significant valve disease

NB: patients with a normal ECG are unlikely to have heart failure

Before referral please speak to HF Service re:

  1. Previous diagnosis of LVSD/Heart Failure by ECHO
  2. BMI > 45
  3. ECHO within past 18 months

Please view referral form here.

NTpro-BNP test requesting guidance

The BNP (NTproBNP) 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, and increase in level according to New York Heart Association classification. If BNP is normal it generally rules out heart failure. (Negative Predictive Value 97%).

The NICE guideline CG108 recommends that NTproBNP is measured in patients with suspected heart failure. NTproBNP testing will not be indicated however when there is:

  • A previous history of myocardial infarction (MI)
  • A confirmed diagnosis of heart failure due to left ventricular systolil dysfunction
  • Atrial fibrillation

A history of previous MI and symptoms and signs of heart failure should prompt urgent referral to GHFS for echocardiogram (using GHFS referral form)

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

Patients with a 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 can all increase NT proBNP.

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

NT-proBNP is analysed by Clinical Biochemistry at Gloucestershire Hopsitals. 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 proBNP levels (as below) should be referred to the Gloucestershire Heart Failure Service.