Direct Access Echocardiogram is suitable for patients with:

1. A new murmur

2. A new diagnosis of Atrial Fibrillation (AF):

NICE guidelines suggest the following patients are referred for echocardiography:

• If a baseline echocardiogram is important for long-term management (such as in a younger patient)
• If considering a rhythm-control strategy that includes electrical or pharmacological cardioversion
• If you suspect underlying structural or functional heart disease (failure or murmur) that would influence management, such as choice of antiarrhythmic drug
• Where needed to help with stratifying stroke risk for antithrombotic therapy, but only where clinical evidence is needed of left ventricular dysfunction or valve disease.

3. Suspected Heart Failure and NTproBNP greater than 400 but less than 2000

• Patients with suspected HF and an NTproBNP greater than 2000 should be referred directly to the Rapid Access HF Outpatient Clinic for urgent assessment. Referrals for patients with an NTproBNP greater than 2000 for a DA echo will be returned.

• HF is very unlikely in patients with an NTproBNP less than 400. Patients with suspected HF and an NTproBNP less than 400 should be referred for a routine general cardiology appointment.

• Patients with an existing diagnosis of heart failure who have developed new symptoms should be referred for a general cardiology outpatient appointment.

• The presence of haemodynamic instability/ decompensated heart failure with pulmonary oedema in the context of rapidly conducted AF is a Red Flag and means the patient warrants admission.

Referral Criteria

Echo requests will be returned to the referrer if:

• Not on the correct form
• Not accompanied by a recent ECG
• NTproBNP level not included (for those referred for the indication of ‘Suspected Heart Failure’)
• Patients with ambulance/hoist requirements

Unfortunately, the Nightingale Hospital is unable to facilitate patients who have ambulance or hoist requirements at this stage.

Referrals will be returned if the criteria are not evident in the referral.

*All other patients should be referred directly to cardiology with a recent ECG*

Referral Instructions

Referral for Echocardiogram

Complete proforma below and attach to e-Referrals

• Specialty: Diagnostics
• Clinic Type: Echocardiography
• Service: DRSS-Western-Echocardiography- Devon ICB-15N / DRSS-Western-Echocardiography-CORNWALL- Devon ICB-15N

Referral to Cardiology

• Specialty: Cardiology
• Clinic Type: Not Otherwise Specified
• Service: DRSS-Western-Cardiology- Devon ICB-15N / DRSS-Western-Cardiology-Cornwall-Devon ICB-15N

Referral Forms

Direct Access Echo Form

Direct Access Echo Form - EMIS

Direct Access Echo Form - Systmone

Pathway Group

This guideline has been signed off on behalf of NHS Devon.

Publication date: April 2022

Updated: July 2023