Screening for earlY Heart Failure Diagnosis and Management in Primary Care or at HOme Using Natriuretic Peptides and echocardiographY "SYMPHONY-HF"

Prior treatment

• Previous documented diagnosis of heart failure
• Current renal replacement therapy

Other illness

• Inability to give informed consent e.g., due to significant cognitive impairment

Other

• Anyone who, in the investigators' opinion, is not suitable to participate in the trial for other reasons e.g., a diagnosis which may compromise survival over the study period

• Male or female ≥40 years of age
• Informed consent
• Two or more of the following risk factors for heart failure:
  • Coronary artery disease (either a previous documented type 1 myocardial infarction or coronary artery bypass grafting or percutaneous coronary intervention or documented stenosis of an epicardial coronary artery \[50% left main stem or \>70% left anterior descending, circumflex or right coronary artery\])
  • An established diagnosis of diabetes (type 1 or type 2)
  • Persistent or permanent atrial fibrillation (not paroxysmal atrial fibrillation)
  • Previous ischemic or embolic stroke
  • Peripheral arterial disease (previous surgical or percutaneous revascularisation or a documented stenosis greater than 50% of a major peripheral arterial vessel).
  • Chronic kidney disease (defined as an estimated glomerular filtration rate \<60mL/min/1.73m2 or eGFR 60-90mL/min/1.73m2 and UACR \>300mg/g).
  • Regular loop diuretic use (any dose at any dosing interval) for \>30 days.
  • COPD (evidenced by one of the following: PFTs showing airway obstruction, diagnosis by respiratory physician, CT scan reporting presence of emphysema or treatment with national guideline advocated COPD therapy).