We recommend conducting a thorough medical history and physical examination when making a diagnosis of HF. Diseases that can cause HF or contribute to its progression should be screened. These include: family history of cardiomyopathy or sudden death; alcohol abuse, hemochromatosis, sarcoidosis, amyloidosis, HIV infection, neuroendocrinopathies (e.g., pheochromocytoma, hypothyroidism), rheumatological diseases (e.g., collagen vascular diseases), nutritional deficiencies (e.g., thiamine) and sleep apnea. (Recommendation Strong, Quality Low).

We recommend that a 12-lead ECG be performed to determine heart rhythm, heart rate, QRS duration and morphology and to detect possible etiologies (Recommendation Strong, Quality Low).

We recommend, if available, the measurement of NP (BNP and NT-proBNP) to rule in or rule out a diagnosis of HF and to obtain prognostic information (Recommendation Strong, Quality High).

We recommend that echocardiography be performed in all patients with suspected HF to assess cardiac structure and function, to quantify systolic function for planning and monitoring of treatment and for prognostic stratification (Recommendation Strong, Quality Moderate).

We recommend coronary angiography to be performed in patients with angina pectoris who are deemed suitable candidates for coronary revascularization to document coronary anatomy (Recommendation Strong, Quality Low).

We recommend a validated measure of severity of symptoms and physical activity, such as the NYHA classification to document functional capacity (Recommendation Strong, Quality High).

Values and Preferences These recommendations place greater value on basic evaluations that are widely available and less value on more advanced tests e.g. CMR that should be reserved for selected patients.