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Management of hospitalised patients with heart failure admitted to non-cardiology services
  1. Robin A P Weir
  1. Cardiology, University Hospital Hairmyres, Glasgow, UK
  1. Correspondence to Dr Robin A P Weir, Cardiology, Hairmyres Hospital, East Kilbride, UK;{at}

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Learning objectives

  • To review the diagnostic pathway for heart failure and to appreciate the differences in natriuretic peptide criteria used in primary (community) and secondary (hospital) care.

  • To understand the negative impact on evidence-based treatment and clinical outcomes (including mortality) of management of patients with heart failure on non-specialist services.

  • To appreciate the importance of specialist heart failure team review in hospital and/or early after discharge and its impact on heart failure diagnosis, treatment, follow-up and clinical outcomes.


Heart failure (HF) is a clinical syndrome characterised by typical symptoms and signs caused by a structural and/or functional cardiac abnormality, which results in reduced cardiac output and/or elevated cardiac filling pressures. It is common, with a prevalence of 1.6% within a population of 4 million UK residents, and accounts for nearly 5% of acute medical hospital admissions.1 2 Guideline-based diagnostic pathways are in widespread use for assessment of the breathless patient in order to exclude or confirm HF, but despite these there is considerable variability in criteria used to define and diagnose this condition.3–5 This variability in diagnosis is evident in both community and hospital care, and even within different departments within the hospital. This results in the potential for underdiagnosis (or overdiagnosis) of HF, underuse (or overuse) of guideline-directed pharmacological therapies, underuse of appropriate implantable cardiac devices, variation in specialist team involvement and follow-up after discharge back into the community, which has an impact on patient outcomes.6 The purpose of this article is to evaluate how HF is diagnosed (and subcategorised) in the hospital setting, and to review the management and outcomes of patients with HF when cared for in cardiology compared with non-cardiology services.

Heart failure diagnosis

With the notable exception of asymptomatic left ventricular (LV) dysfunction, which is detected when cardiac imaging is performed for indications other than symptoms of …

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  • Contributors This manuscript is my original work as sole author.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.

  • Author note References which include a * are considered to be key references.