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Cardiovascular GPs split on practicality of NICE heart failure guidelines



By Craig Kenny

GPs are divided over the practicality of draft NICE guidelines that encourage rapid referral for echocardiography for the diagnosis of heart failure.

One GPSI, who has been forced to close his primary care echocardiography clinic this month because of a lack of support from specialists, told Pulse the plans were ‘unworkable’.

The draft NICE guidance released this month says GPs should urgently refer patients with previous myocardial infarction and suspected heart failure to a specialist for an echocardiogram within two weeks.

In another major change to the guidance, they urge GPs to use beta natiuretic peptide testing rather than ECG first for patients with no prior MI if they suspect heart failure. If levels are very high they should refer for an echocardiography within two weeks.

Dr Ahmet Fuat, a cardiology GPSI in Darlington and a member of the NICE guideline development group, said the guidance was ‘realistic’ and would not lead to an increase in referrals.

‘There is some evidence that use of BNP testing may reduce referrals to echo services as there are fewer false positives. So there won’t be huge numbers.’

‘The guidance is about stratifying and prioritising at-risk patients so they are seen quicker. This hopefully gives local GPs and practice-based commissioners some leverage to get quick assessments,’ he said.

But others disagree. Dr Gerald Partridge, a cardiology GPSI in, Keighley, West Yorkshire, said he had been forced to close his primary care echocardiography clinic after seven years last week due to a lack of support from hospital specialists.

‘I think the guidance will be unworkable,’ he said. ‘Waiting times at our local hospital clinic are 12 weeks – mine were around three.

Dr Partridge said he could not get the support of secondary care colleagues for his four-year reaccreditation, despite the fact that he was much faster than the hospital at sending his echocardiography report back to GPs.

‘I sent my report electronically to the patient’s GP 20 minutes after the echo was done – mine was the only clinic in Yorkshire to do this,’ he said.

Cardiovascular GPs are split on the practicality of new draft NICE heart failure guidelines