Heart failure

Cardiovascular · Known disease · updated 2026-10-31

BioMG follows French guidelines. Adapt it to the guidelines and the tests available where you practise.

Frequency: In France, 853 700 people (1.3% of the population) are treated for heart failure (2024), of whom 673 610 for chronic heart failure ^[1].

Initial tests

Fasting sample.

NT-proBNP
FBC
Serum sodium, serum potassium,
Serum creatinine with eGFR
Serum albumin
Urea
Lipid profile
Fasting plasma glucose
AST
ALT
GGT
Alkaline phosphatase
TSH
Serum ferritin (if reduced ejection fraction)if needednon-French guidelineHeart failure with reduced ejection fraction: iron studies recommended by NICE (ferritin, transferrin saturation, haemoglobin), with intravenous iron to be discussed if ferritin < 100 ng/mL or transferrin saturation < 20% ^[2].
Transferrin saturation (if reduced ejection fraction)if needednon-French guidelineSame indication as ferritin: iron deficiency defined by ferritin < 100 ng/mL or transferrin saturation < 20% ^[2].
HbA1c (if known diabetes)if needednon-French guidelineNICE, ESC and the German recommendation (2019 chapter, under revision) list HbA1c alongside plasma glucose, or in its place for NICE; the HAS guide asks for plasma glucose ^[2,3,4,5].

Urine dipstick (to look for a renal cause of the symptoms or an aggravating factor)if needednon-French guidelineNICE (to be considered, to look for an aggravating factor or another diagnosis), ACC/AHA/HFSA (class 1, expert opinion) and the German recommendation (2019 chapter, under revision) list urine tests; the 2014 HAS guide does not mention them ^[2,3,5,6].

Detailed explanation and international comparison (in French): read it in English (machine translation)

Serum digoxin: do not measure routinely; useful only 8 to 12 hours after the last dose to confirm suspected clinical toxicity or non-adherence ^[2].

Detailed explanation and international comparison (in French): read it in English (machine translation)

NT-proBNP or BNP at every routine check: HAS proposes it only if decompensation is suspected ^[3]; NICE advises measuring it to optimise treatment only in specialist care, before age 75, with a GFR > 60 mL/min/1.73 m² ^[2].
BNP on sacubitril/valsartan: cannot be interpreted, as it is raised by the treatment itself ^[10].

Serum electrolytes
Serum creatinine with eGFR
Urea
Serum albumin
FBCif neededIntercurrent event.
ASTif neededIntercurrent event.
ALTif neededIntercurrent event.
GGTif neededIntercurrent event.
Alkaline phosphataseif neededIntercurrent event.
Serum ferritinif needednon-French guidelineNICE includes iron status and haemoglobin in the minimum follow-up of every heart failure (review at least every six months) ^[2].
Transferrin saturationif needednon-French guidelineNICE includes iron status and haemoglobin in the minimum follow-up of every heart failure (review at least every six months) ^[2].

Detailed explanation and international comparison (in French): read it in English (machine translation)

Detailed explanation and international comparison (in French): read it in English (machine translation)

Sources (12)