Referral to emergency

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.

  • new murmur with any red flags:
    • haemodynamic instability
    • persistent or progressive shortness of breath (New York Heart Association Class III – IV)
    • chest pain
    • syncope/pre-syncope/dizziness
    • neurological deficit indicative of transient ischaemic attack/stroke
    • fever or other symptoms suggestive of infection (e.g. endocarditis, acute rheumatic fever)
    • signs of heart failure (HF)
  • suspected endocarditis

For clinical advice, please telephone the relevant specialty service.

Central Adelaide Local Health Network

Northern Adelaide Local Health Network

Southern Adelaide Local Health Network

Category 1 — appointment clinically indicated within 30 days

  • murmur with heart failure (HF) symptoms without red flags
  • severe valve stenosis or regurgitation as described on echocardiogram (Echo) report without red flags
  • moderate valve stenosis or regurgitation as described on Echo report with normal ventricular function, and no pulmonary hypertension.

Category 2 — appointment clinically indicated within 90 days

  • moderate valve stenosis or regurgitation as described on echo report with normal ventricular function, and no pulmonary hypertension
  • patients needing an Echo

Category 3 — appointment clinically indicated within 365 days

  • asymptomatic murmur

Essential referral information

Completion required before first appointment to ensure patients are ready for care. 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.

  • description of symptoms, frequency, duration and risk factors
  • details of all treatments offered and efficacy
  • presence of red flags
  • people identifying as Māori, Aboriginal and/or Torres Strait Islander - increased risk of acute rheumatic fever and rheumatic heart disease
  • past medical history, including acute rheumatic fever/rheumatic heart disease and comorbidities
  • family history of cardiac disease or sudden cardiac death
  • complete blood examination (CBE)
  • urea, electrolytes, creatinine (UEC)
  • liver function tests (LFTs)
  • blood sugar levels
  • estimated glomerular filtration rate (eGFR)
  • thyroid stimulating hormone (TSH)

Additional information to assist triage categorisation

  • echocardiogram (Echo)
  • chest X-ray
  • electrocardiogram (ECG)
  • fasting lipids
  • gestational and development history, stage and estimated date of delivery if appropriate
  • use/frequency of alcohol, tobacco and other drugs

Clinical management advice

Patients who have been seen by a specialist cardiologist previously, are encouraged to be referred back to their care for further review.

Where structural heart disease is suspected consider echocardiogram (Echo). There is limited capacity to offer an Echo only option and the report will be sent to referrer without cardiology input. Patients can subsequently be referred for review in the event of a significant finding.

Clinical resources

Consumer resources

Reason for request

  • to establish a diagnosis
  • for treatment or intervention
  • for advice and management
  • for specialist to take over management
  • for a specified test/investigation the General Practitioner cannot order
  • for other reason (e.g. rapidly accelerating disease progression)
  • transfer of care from another tertiary service
  • clinical judgement indicates a referral for specialist review is necessary.

Patient demographic details

  • 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

Clinical modifiers

  • 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

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.
  • Relevant social history, including identifying if you feel your patient is from a vulnerable population, under guardianship/out-of-home care arrangements and/or requires a third party to receive correspondence on their behalf.
  • Triage of a specialist outpatient referral is based on clinical decision making to allocate an appropriate urgency categorisation.
  • 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 public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.
  • A change in patient circumstance (such as condition deteriorating or pregnancy) may affect the urgency categorisation and should be communicated as soon as possible.
  • All new referrals will be triaged by a consultant and appointment times scheduled according to clinical urgency.