Indications for Referral to Subspecialty Cardiology

Immediate/Urgent Cardiology Referral Required

The American College of Cardiology recommends referring patients immediately to cardiology if they have documented or suspected ventricular arrhythmias with syncope, preexisting cardiac disease, or survivors of sudden cardiac death 1, 2, 3
Patients with preexisting cardiac disease, including coronary heart disease, heart failure, valvular heart disease, severe pulmonary hypertension, or significant arrhythmias, require immediate cardiology referral 1
Survivors of sudden cardiac death or those with special occupational requirements should be referred to cardiology 4, 3
Documented ventricular arrhythmias or syncope where VA is documented or thought to be the likely cause require hospitalization for evaluation, monitoring, and management 2
Cardiomyopathy with LVEF persistently <40% requires tailored heart failure medical therapy and consideration of device therapy 1

Patients with chest pain and angina-equivalent symptoms without known coronary disease should be considered for noninvasive and/or invasive imaging 1, 4
Typical angina, especially with cardiac risk factors, requires cardiology evaluation 4, 3
Atypical presentations in high-risk groups, such as women or elderly patients, should be evaluated by cardiology 4, 3

Sustained palpitations with associated symptoms, including shortness of breath, chest pain, dizziness, near syncope, or syncope, require cardiology evaluation 2
Family history of sudden cardiac death, sudden cardiac arrest, or cardiac channelopathies in first-degree relatives should be referred to cardiology 2

Patients with ≥3 cardiovascular risk factors, including age, diabetes, hypertension, hyperlipidemia, smoking, family history of premature coronary artery disease, peripheral vascular disease, left ventricular hypertrophy, prior cerebrovascular event, or proteinuria, should be referred for cardiovascular disease screening and optimization 1, 7
Abnormal resting ECG showing left ventricular hypertrophy, ST-T wave changes consistent with ischemia, or evidence of previous Q-wave MI requires cardiology evaluation 4, 3
Abnormal stress testing or prior abnormal cardiac stress test results should be referred to cardiology 5
Echocardiogram findings suggestive of underlying coronary disease, cardiomyopathy, or valvular abnormalities require cardiology evaluation 1, 8

All kidney or liver transplant candidates should have cardiology participation in multidisciplinary candidate selection committees 1
Heart failure patients should be referred for initial assessment of ability to perform activities of daily living, volume status assessment, and comprehensive laboratory evaluation 8
Coronary arteriography should be performed in heart failure patients who have angina or significant ischemia unless contraindicated 8