Most patients with new-onset heart failure (HF) will present to a primary care provider with symptoms of fatigue, breathlessness and ankle swelling. Diagnosis can be challenging given the nonspecific nature and frequency of these symptoms in the general population as well as time constraints and competing primary care issues. In an effort to understand current adherence to recommended pathways for diagnosis of HF in primary care, Hayhoe and colleagues1 linked primary and secondary care data from the UK Clinical Practice Datalink. Of the over 42 thousand patients diagnosed with HF over a 4 year time period, about 40% presented to a primary care provider with HF symptoms. However, only 39% underwent echocardiography or a serum natriuretic peptide test, with an average delay of almost 10 months from symptom onset to diagnostic testing and a total delay from symptoms to HF treatment over 2 years. (figure 1)…

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