Direct Access Echocardiogram

Direct Access Echocardiogram is suitable for:

1. Patients with a new murmur who are otherwise fit and well

2. Patients confirmed with a new diagnosis of Atrial Fibrillation (AF), NICE (2006) 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.

Please note that echocardiogram is no longer the test of choice for diagnosing patients with breathlessness in whom heart failure is suspected. These patients should have instead NT proBNP testing and if this exceeds 400pcg/ml refer promptly to cardiology with a referral letter, NT proBNP result, recent ECG (not mandated if NT proBNP greater than 2000) and summary print-out. Echocardiogram and further management will be arranged.

If you wish to request an echocardiogram for any other clinical indication, then please refer to cardiology with a recent ECG

Please follow the below links for further information:

• Heart Failure – Suspected Heart Failure For Patients With NTproBNP lower than 2000 or know/previously diagnosed

• Heart Failure Heart Failure – Suspected Heart Failure For Patients with NTproBNP greater than 2000

Referral Criteria

Echo requests will be returned to the referrer if:

• Not on the correct form
• Not accompanied by a recent ECG

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

*All other patients should be referred directly for cardiological opinion* and DRSS will now be returning any referrals outside of the agreed criteria for re-referral through the correct route with immediate effect.

Referral Instructions

Referral for Echocardiogram

Complete proforma below and attach to e-Referrals

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

Referral to Cardiology

• Specialty: Cardiology
• Clinic Type: Not Otherwise Specified
• Service: DRSS-Western-Cardiology- Devon CCG-15N / DRSS-Western-Cardiology-Cornwall-Devon CCG-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 by the Western Locality on behalf of NHS Devon CCG.

Publication date: April 2022