Post Acute Cardiac Conditions
Adult

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Emergency Referrals

Important

If you believe your patient requires immediate attention, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice.

Angina / myocardial ischaemia / chest pain

Suspected acute coronary syndrome
Suspected pulmonary embolism or aortic dissection
Suspected or confirmed endocarditis, myocarditis or pericarditis or pericarditis
Suspected ischaemic chest pain within 24 hours that is associated with any of the following concerning features:
- Severe or ongoing chest pain
- Ischemic chest pain lasting ten minutes or more
- Recurrent chest pain that is new at rest or occurring with minimal activity
- Chest pain accompanied by severe dyspnoea
Chest pain associated with any of the following clinical signs:
- syncope / pre-syncope
- o respiratory rate > 30 breaths per minute
- tachycardia >120
- systolic BP < 90mmHg
- heart failure / suspected pulmonary oedema
- ST elevation or depression
- complete heart block
- new left bundle branch block

Atrial fibrillation / flutter

Atrial fibrillation / flutter with any of the following concerning features:
Haemodynamic instability
Shortness of breath
Chest pain
Syncope/pre-syncope/dizziness
Evidence of pre-excited QRS (delta waves)
Neurological deficit indicative of TIA/stroke
Uncontrolled Tachycardia/heart rate despite medical therapy

Aortic Disease

Suspected chest pain within 24 hours that is associated with any of the following concerning features:
Severe or ongoing chest pain
Ischemic chest pain lasting ten minutes or more
Recurrent chest pain that is new at rest or occurring with minimal activity
Chest pain accompanied by severe dyspnoea

Chest pain associated with any of the following clinical signs:

syncope / pre-syncope
respiratory rate > 30 breaths per minute
tachycardia >120 bpm
systolic BP < 90mmHg
heart failure / suspected pulmonary oedema
ST elevation or depression
complete heart block
new left bundle branch block
Heart Failure

Acute or chronic heart failure with any of the following concerning features:

NYHA Class IV heart failure
- Ongoing chest pain
- Significant orthopnoea/PND
- Oxygen saturation < 90%
- Clinical and/or radiographic signs of acute pulmonary oedema
- Haemodynamic instability:
- pre-syncope / syncope / severe dizziness
- altered level of consciousness
- heart rate > 120 beats per minute
- systolic BP < 90mmHg with symptoms of hypoperfusion
- systolic BP < 80mmHg irrespective of symptoms
Significant pulmonary or pedal oedema
Recent myocardial infarction (within 2 weeks)
Pregnant patient
Signs of myocarditis
Signs of acute decompensated heart failure
- NB: Early discussion with the patient’s usual heart failure team would be advised for local care protocols

Hypertension

Hypertensive emergency (BP>220/140)
Severe hypertension with systolic BP >180mmHg with any of the following concerning features:
Headache
Confusion
Blurred vision
Retinal haemorrhage
Reduced level of consciousness
Seizures
Proteinuria
Papilloedema
Signs of heart failure
Chest pain
If suspected pregnancy induced hypertension or pre-eclampsia refer patient to the emergency department of a facility that offers obstetric services where possible

Murmur

New murmur with any of the following concerning features:
- Haemodynamic instability
- Persistent or progressive shortness of breath (NYHA Class III – IV)
- Chest pain
- Syncope / pre-syncope / dizziness
- Neurological deficit indicative of TIA/stroke
- Abnormal ECG (e.g. LV hypertrophy, AF, LBBB, RBBB)
- Fever or constitutional symptoms suggestive of infection (eg endocarditis, acute rheumatic fever)
- Signs of heart failure

Palpitations

Palpitations with any of the following concerning features:
- chest pain
- shortness of breath
- loss of consciousness
- syncope / pre-syncope
- persisting tachyarrhythmia on ECG

Supraventricular tachycardia

Unresolved acute supraventricular tachycardia with any of the following concerning features
Syncope
Severe dizziness
Ongoing chest pain
Increasing shortness of breath
Hypotension
Signs of cardiac failure
Ventricular rate >120 bpm

Syncope/pre-syncope

Syncope with any of the following concerning features:
- Exertional onset
- Chest pain
- Persistent hypotension (systolic BP <90mmHg)
- Severe persistent headache
  - Focal neurological deficits
- Preceded by or associated with palpitations
- Known ischaemic heart disease or reduced LV systolic function
- Associated with SVT or paroxysmal atrial fibrillation
- Evidence of pre-excited QRS (delta waves) on ECG
- Suspected malfunction of pacemaker or ICD
- Absence of prodrome
- Associated injury
- Occurs while supine
- Seizures

Useful Management Information

Clients referred to the Better Cardiac Care Program can also access the wider multidisciplinary Chronic Disease and Post Acute Programs Team including the below clinicians:

A&TSI Nurse Navigation
Social Work
Occupational Therapist
Speech Pathologist
Dietician
Psychologist
Podiatrist
Exercise Physiologist
Diabetes Nurse Educator/Nurse Practitioner

The Better Cardiac Care program operates 5 days per week from 0700 – 1600 Monday to Friday

Please note that where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service. Access to some specific services may include initial assessment and management by associated allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist

Minimum Referral Criteria

Does your patient meet the minimum referral criteria?

Category 1 (appointment within 30 calendar days)	Medically stable post myocardial infarction (>2-3 weeks post NSTEMI; 3-4 weeks post STEMI); with or without Percutaneous Coronary Intervention (PCI) PTCA elective intervention (>2weeks post PCI) Stable angina CABG surgery (>4 weeks post CABG) Valvular surgery (> 4weeks post surgery) Pacemaker and ICD insertion (>4 weeks post surgery) Stable cardiomyopathy Heart transplant (>4 weeks post surgery High risk for cardiovascular disease with three or more of the following risk factors; family history of cardiovascular disease smoking o unhealthy weight high cholesterol high blood pressure depression and social isolation diabetes physical inactivity chronic stress
Category 2 (appointment within 90 calendar days)	No category 2 criteria
Category 3 (appointment within 365 calendar days)	No category 3 criteria
If your patient does not meet the minimum referral criteria Assessment and management information may be found on a range of conditions at HealthPathways If the patient does not meet the criteria for referral but the referring practitioner believes the patient requires specialist review, a clinical override may be requested: 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

Standard Referral Information

Reason for request

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

Relevant clinical information about the condition

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
All conservative options that have been pursued unsuccessfully prior to referral
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
Any special care requirements where relevant (e.g tracheostomy in place, oxygen required)
Current medications and dosages
Drug allergies
Alcohol, tobacco and other drugs use

Patient's Demographic Details

Full name (including aliases)
Date and country of birth
Residential and postal address including whether patient resides at an aged care facility
Telephone contact number/s – home, mobile and alternative
Medicare number (where eligible)
Name of the parent or caregiver (if appropriate)
Name of delegate and contact details (Department of Corrective Services)
Preferred language and interpreter requirements
Identifies as Aboriginal and/or Torres Strait Islander
Any special needs, access requirements and/or disability relevant to the referral

Referring Practitioner Details

Full name
Full address
Contact details – telephone, fax, email
Provider number
Date of referral
Signature
Nominated general practitioner’s details (if known), if the nominated general practitioner is different from the referring practitioner

Other relevant information

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.)

Essential Referral Information

Please indicate whether the following investigations have been undertaken for this referral to be processed and attach:

Medical and surgical history
If client is to participate in the exercise portion of the program - medical clearance to exercise
FBC, lipids, EFTS, HbA1C
Please attach medication list
In addition, please also attach any investigation results you consider to be relevant, including coronary angiography, myocardial perfusion scan, echocardiography and/or exercise stress test results

Additional Referral Information

A change in patient circumstances (such as condition deteriorating or becoming pregnant) may affect the urgency categorisation and should be communicated as soon as possible
Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally
If your patient consents to telehealth, please indicate in the body of the referral

Send Referrals To

Smart Referrals

Preferred Method About Smart Referrals

Secure Web Transfer

Medical Objects Account: GQ42150009Z

HealthLink EDI: Qldgchsd

Internal Referrals

Better Cardiac Care - Aboriginal and Torres Strait Islander Service qhRefer

Fax

(07) 5687 4497

Post

Better Cardiac Care 1 Hospital Boulevard Southport QLD 4215

Enquiries

1300 668 936

Related HealthPathways

No directly related pathways found

HealthPathways home page

Service Availability

Dr Ben Chen

Facilities

Robina Health Precinct

If you would like to send a named referral, please address it to the specialist listed above, who will allocate a suitably qualified specialist to see the patient. Alternatively, you can view a full list of our specialists.

Post Acute Cardiac ConditionsAdult