Introduction

Heart failure (HF) is a clinical syndrome characterised by typical symptoms and signs caused by a structural and/or functional cardiac abnormality, which results in reduced cardiac output and/or elevated cardiac filling pressures. It is common, with a prevalence of 1.6% within a population of 4 million UK residents, and accounts for nearly 5% of acute medical hospital admissions.1 2 Guideline-based diagnostic pathways are in widespread use for assessment of the breathless patient in order to exclude or confirm HF, but despite these there is considerable variability in criteria used to define and diagnose this condition.3–5 This variability in diagnosis is evident in both community and hospital care, and even within different departments within the hospital. This results in the potential for underdiagnosis (or overdiagnosis) of HF, underuse (or overuse) of guideline-directed pharmacological therapies, underuse of appropriate implantable cardiac devices, variation in specialist team involvement and follow-up after discharge back into the community, which has an impact on patient outcomes.6 The purpose of this article is to evaluate how HF is diagnosed (and subcategorised) in the hospital setting, and to review the management and outcomes of patients with HF when cared for in cardiology compared with non-cardiology services.