Practical approach to referral from primary health care to a cardiology hospital consultation in 2022

Rev Port Cardiol. 2023 Jun;42(6):557-578. doi: 10.1016/j.repc.2022.01.007. Epub 2022 Apr 22.
[Article in English, Portuguese]


In Portugal, up to 38% of the population has cardiovascular disease, which highlights the importance of primary health care (PHC) in its management. Adequate management of people with cardiovascular disease often requires hospital referral for a cardiology consultation. However, it is not always easy to ascertain which situations should be referred, especially given that PHC does not have access to all diagnostic exams recommended by international guidelines, such as natriuretic peptides in heart failure or computed tomography coronary angiogram in chronic coronary syndromes, among others. The aim of this document is to describe a practical approach to the most frequent heart diseases that may require a referral for a hospital cardiology consultation. Thus, in the different chapters, the recommendations for referral are highlighted generically according to group of disease, as well as, albeit briefly, the initial clinical approach within the scope of PHC for a differential diagnosis and more efficient follow-up. A modified Metaplan methodology was used. A panel of 4 cardiology specialists and 3 specialists in General and Family Medicine developed this document, which should not be taken as an official guideline, but as additional guidance for the correct referral of patients. It is therefore advisable to validate these recommendations locally with the referral hospital, as well as to be aware of the respective international and national guidelines.

Keywords: Arrhythmias; Arritmias; Atrial fibrillation; Cardiology consultation; Chronic coronary syndrome; Consulta de Cardiologia; Cuidados de Saúde Primários; Doença valvular; Fibrilhação auricular; Heart Failure; Hipertensão; Hospital referral; Hypertension; Insuficiência cardíaca; Primary health care; Referenciação hospitalar; Syncope; Síncope; Síndrome coronária crónica; Valvular disease.

Publication types

  • Review
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cardiology*
  • Cardiovascular Diseases*
  • Hospitals
  • Humans
  • Primary Health Care
  • Referral and Consultation