• left ventricular dysfunction
• hand held echocardiography
• brain natriuretic peptide

• BNP, brain natriuretic peptide
• LV, left ventricular
• LVEF, left ventricular ejection fraction
• LVSD, left ventricular systolic dysfunction
• NT BNP, N terminal pro-brain natriuretic peptide

Heart failure is a growing and increasingly important chronic disease of the western world, occurring in at least 2% of the adult population and rising to 3% in those aged over 75 years.^1,2 In a recently conducted study in Harrow of 1400 subjects who were invited to undergo echocardiography for assessment of left ventricular (LV) function the overall prevalence of symptomatic and asymptomatic LV dysfunction was 2% and rising to 8% above the age of 65 years (fig 1).³ Although the incidence of most cardiovascular diseases has declined over the past 20 years, the incidence of heart failure has continued to rise, due to the fact that more people are surviving after acute myocardial infarction and also to the increasing number of elderly people.⁴ A diagnosis of heart failure is associated with high mortality, morbidity, and cost.⁵ It has a worse prognosis than breast cancer or prostate cancer and is second only to stroke in terms of health care costs.⁶ Heart failure costs the USA over $8 billion (£5 billion) each year and 5% of all admissions in the UK have a diagnosis of heart failure.⁷ Indeed, hospital admission accounts for 70% of the cost of heart failure due to the number of day beds that are occupied.⁵

Early detection of heart failure caused by left ventricular systolic dysfunction (LVSD) is important as early initiation of drug treatment, including angiotensin converting enzyme inhibitors, β blockers, and aldosterone receptor antagonists, has been shown to reduce mortality, morbidity, and hospitalisation.^8,9 Indeed, it has been shown that early initiation of treatment in asymptomatic left ventricular dysfunction will prevent or retard progression to heart failure.¹⁰ However, …