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Heart Failure: Investigations and Monitoring
Scope
The commonest cause of heart failure in the UK is coronary artery disease, and many patients have had a myocardial infarction in the past. Therefore we recommend annual monitoring to assess cardiovascular risk factors and renal function.
Out of scope
BNP and NT-proBNP are both useful "rule in" tests for suspected heart failure, but not appropriate for monitoring heart failure in primary care.
Annually
- Blood - Renal, HbA1C, non-HDL cholesterol (non-fasting)
Routine monitoring of digoxin levels is not recommended. A digoxin concentration measured at least 6 hours after the last dose may be useful to confirm a clinical impression of toxicity or non-adherence. Toxicity may occur even when the concentration is within the 'therapeutic range.'
BNP and NT-proBNP are both useful "rule in" tests for suspected heart failure, but not appropriate for monitoring heart failure in primary care.
Evidence
Chronic heart failure: Management of chronic heart failure in adults in primary and secondary care. NICE guidelines [CG108]. Published: August 2010
Lipid modification: cardiovascular risk assessment and the modification of blood lipids for the primary and secondary prevention of cardiovascular disease. NICE guideline [CG181]. Published: July 2014.
Pathway Group
This guideline has been signed off by the Pathology Optimisation Clinical Group on behalf of NHS Devon.
Publication date: June 2017
