Indications for Referral of Patient with Heart Failure to Cardiologist

Is the diagnosis of heart failure in doubt with available resources?

Does the patient have a significant murmur and valvar heart disease?

Does the patient have a significant arrhythmia?

Is the heart failure secondary to an endocrine or other cause?

Is severe left ventricular impairment present?

Is there a pre-existing or developing metabolic and/or renal abnormality?

Does the patient have severe vascular disease?

Did the patient have relative hypotension prior to ACE inhibitor therapy?

Has the patient shown a poor response to treatment?

Is there some aspect to the patient's heart failure not listed above for which you feel that a specialist's skill may be helpful in optimizing management?