Roalfe et al developed a clinical decision rule for identifying heart failure in primary care. This can help to identify patients who should be referred to echocardiography. The authors are from multiple institutions in England, Australia, New Zealand and the Netherlands.
Patient selection: adult in primary care
Indications to refer a patient for echocardiography:
(1) male with ankle edema
(2) history of myocardial infarction
(3) basal crepitations on lung exam
If none of these indications are present, then a serum natriuretic tests (BNP, NT-proBNP) is ordered and the patient referred if the test is elevated for age, gender and renal function..
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