From the Guidelines
The primary reason for consulting a specialist in a patient with suspected heart failure is the presence of reduced Ejection Fraction (EF), as it is a key indicator of heart failure severity and guides treatment decisions, according to the 2021 update to the 2017 ACC expert consensus decision pathway for optimization of heart failure treatment 1. When evaluating a patient with suspected heart failure, several factors can prompt specialist consultation, including new-onset heart failure, high-risk features, persistently reduced LVEF, and the need for a second opinion regarding etiology.
- New-onset heart failure, regardless of EF, warrants referral for evaluation of etiology, guideline-directed evaluation and management of recommended therapies, and assistance in disease management.
- High-risk features, such as the need for chronic intravenous inotropes, persistent NYHA functional class III–IV symptoms, or clinical deterioration, also necessitate specialist consultation.
- A persistently reduced LVEF (#35%) despite guideline-directed medical therapy (GDMT) for $3 months is another indication for referral, as it may require consideration of device therapy.
- The need for a second opinion regarding etiology, such as coronary ischemia, valvular heart disease, or suspected myocarditis, also warrants specialist consultation. While elevated Brain Natriuretic Peptide (BNP) and hypoxemia are important diagnostic markers and indicators of heart failure severity, they typically do not necessitate emergency specialist consultation unless accompanied by clinical deterioration.
- Elevated BNP levels can indicate heart failure, but the decision to consult a specialist should be based on the overall clinical context, including symptoms, physical examination, and other diagnostic findings.
- Hypoxemia, indicated by low oxygen saturation, is a critical condition that requires prompt evaluation and management, but it is not the primary reason for consulting a specialist in a patient with suspected heart failure. Obesity is a risk factor for heart failure but is not an acute indication for specialist referral.
- Obesity can contribute to the development of heart failure, but it is not a direct indicator of heart failure severity or a reason for urgent specialist consultation. In summary, the primary reason for consulting a specialist in a patient with suspected heart failure is the presence of reduced EF, as it is a key indicator of heart failure severity and guides treatment decisions, according to the 2021 update to the 2017 ACC expert consensus decision pathway for optimization of heart failure treatment 1.
From the Research
Primary Reason for Consulting a Specialist
The primary reason for consulting a specialist in a patient with suspected heart failure is not explicitly stated in the provided studies. However, the studies suggest that reduced Ejection Fraction (EF) is a significant indicator of heart failure, and patients with low EF may benefit from specialist consultation.
Indicators of Heart Failure
Some indicators of heart failure mentioned in the studies include:
- Reduced Ejection Fraction (EF) 2, 3, 4
- Elevated Brain Natriuretic Peptide (BNP) is not mentioned in the provided studies
- Hypoxemia is not mentioned in the provided studies as a primary reason for consulting a specialist
- Obesity is not mentioned in the provided studies as a primary reason for consulting a specialist
Treatment of Heart Failure
The studies discuss various treatments for heart failure, including:
- Diuretics 5, 6, 2, 3, 4
- Angiotensin-converting enzyme (ACE) inhibitors 6, 2, 3, 4
- Beta-blockers 2, 3, 4
- Inotropes 5
- Mineralocorticoid receptor antagonists 6
- Angiotensin-receptor-neprilysin inhibitors 6
- Intravenous iron substitution 6
- Mechanical circulatory support 6
- Implantable converter defibrillators 6
- Cardiac resynchronization therapy 6