Heart failure

Red flags

Immediate referral to Emergency Department for patients with any of the following:

  • signs and symptoms suggestive of acute heart failure (HF)
  • decompensated chronic HF
  • other cardiac event

Indications for immediate referral to emergency department include:

  • recent myocardial infarct:
    • within 2 weeks
  • chest pain, where patient:
    • currently has chest pain
    • has had prolonged chest pain in the last 12 hours
    • worsening angina
  • acute pulmonary oedema:
    • acute respiratory distress
    • oxygen saturation < 90%
    • agitation
    • not responding to diuretics
  • arrhythmia:
    • associated with haemodynamic instability
    • tachyarrhythmia, eg:
      • fast atrial fibrillation (heart rate >100 bpm)
    • ventricular tachycardia (VT) - does not always have associated haemodynamic instability
  • new heart murmur
  • hypotension – with evidence of end organ hypoperfusion, eg:
    • dizziness/syncope
    • altered level of consciousness
    • agitation
    • cool clammy skin
    • renal dysfunction, eg:
      • increasing creatinine
    • BP < 90mmHg as a guide but compare to patient’s baseline
  • syncope
  • current pregnancy


It is important to perform an ECG but this should not delay the transfer of the patient to hospital. ECG changes may be seen suggestive of:

  • ischaemia or infarct
  • arrhythmia, particularly if there is haemodynamic instability.

Does your patient wish to be referred?

Minimum referral criteria

Does your patient meet the minimum referral criteria?

Category 1

Appointment within 30 days is desirable

  • NYHA Class III heart failure with worsening symptoms but without Red flag

Category 2

Appointment within 90 days is desirable

  • NYHA Class II heart failure with worsening symptoms
  • Suspected or newly diagnosed heart failure

Category 3

Appointment within 365 days is desirable

  • No Category 3 criteria

If your patient does not meet the minimum referral criteria

Consider other treatment pathways or an alternative diagnosis.

If you still need to refer your patient:

  • Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.)
  • Please note that your referral may not be accepted or may be redirected to another service

Other important information for referring practitioners

Not an exhaustive list

Referral requirements

A referral may be rejected without the following information.

  • General referral information
  • Details of relevant signs and symptoms
  • Details of all treatments offered and efficacy
  • Relevant previous medical history and co-morbidities
  • BP
  • Weight, height & BMI
  • Recent fluctuations in weight indicative of cardiac dysfunction (if known)
  • New York Heart Association (NYHA) class
  • FBC, ELFTs, fasting lipids, HbA1c (if diabetic), TSH results
  • ECG
  • CXR report

Additional Referral Information (Useful for processing the referral)

  • Echocardiogram report
  • Stress test report (if performed)
  • BNP or NT-pro-BNP results
  • Investigations relevant to co-morbidities
  • Respiratory function tests if patient a smoker, has COPD or asthma
  • Iron studies
  • Sleep study report if OSA suspected
  • Aboriginal or Torres Strait Islander or Maori/Pacific Islander / Refugee status (increased risk of acute rheumatic fever and rheumatic heart disease)
  • History of smoking, alcohol intake and drug use (including recreational drugs)

Out of catchment

Metro North Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service. If your patient lives outside the Metro North Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.

  • Impact on employment
  • Impact on education
  • Impact on home
  • Impact on activities of daily living
  • Impact on ability to care for others
  • Impact on personal frailty or safety
  • Identifies as Aboriginal and/or Torres Strait Islander
  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can’t order, or the patient can’t afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary
  • Presenting symptoms (evolution and duration)
  • Physical findings
  • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
  • Body mass index (BMI)
  • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
  • Current medications and dosages
  • Drug allergies
  • Alcohol, tobacco and other drugs use
  • Full name (including aliases)
  • Date of birth
  • Residential and postal address
  • Telephone contact number/s – home, mobile and alternative
  • Medicare number (where eligible)
  • Name of the parent or caregiver (if appropriate)
  • Preferred language and interpreter requirements
  • Identifies as Aboriginal and/or Torres Strait Islander
  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature
  • Willingness to have surgery (where surgery is a likely intervention)
  • Choice to be treated as a public or private patient
  • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)

Send referral

Hotline: 1300 364 938

Fax: 1300 364 952

Electronic: eReferral system

Mail: Metro North Central Patient Intake
Aspley Community Centre
776  Zillmere Road

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