Assessment and diagnosis of heart failure.

Diagnosis is the first essential step in the provision of good management of heart failure. Diagnosis of heart failure by clinical means alone may be fairly accurate in advanced heart failure but will only be correct in about 50% of milder cases; little better than guessing. The number of patients with mild heart failure in whom the diagnosis is not even considered is unknown. In at risk groups, such as those who have had a myocardial infarction, symptoms alert the clinician to a possible diagnosis of heart failure which must be confirmed by further investigation. The echocardiogram is the single most useful diagnostic tool for heart failure in widespread use at the present. Once it is established that the patient has heart failure, its cause must be sought out. As the majority of patients with heart failure are elderly, concomitant diseases may complicate management and should be sought out. European Society Guidelines on the Diagnosis of Heart Failure have been published and provide a minimum data set of investigations that should be carried out in all patients.