Over 900 000 people in the UK have a heart failure (HF) diagnosis, with its incidence and prevalence highest among older people — the average age at diagnosis is 77 years.1 HF is associated with frequent hospitalisations and reduced health-related quality of life and, therefore, represents a considerable health burden for patients and the NHS as a whole.2,3

This editorial will highlight the vital role that primary care has in the diagnosis and management of HF, particularly the form of HF where ejection fraction (EF) is preserved.

There are three main categories of HF, as defined by the European Society of Cardiology (ESC) 2021 guidelines: HF with reduced ejection fraction (HFrEF), where left ventricular ejection fraction (LVEF) is ≤40%; HF with mildly reduced ejection fraction (HFmrEF), where LVEF is 41%–49%; and HF with preserved ejection fraction (HFpEF), where LVEF is ≥50%.4 Approximately half of all HF is thought to be HFpEF, a patient population that currently has a large unmet clinical need. This is due to the challenges of making an accurate diagnosis, availability of HF services that manage HFpEF, and a historical lack of efficacious pharmacotherapy.5

Figure 1 illustrates the different classifications of HF; while some key risk factors overlap, the underlying pathophysiological mechanisms differ between the classifications. When considered alongside the signs and symptoms of HF, the typical patient profiles may aid with the identification of patients with suspected HF presenting to primary care.4,6–8

The different categories of heart failure, their associated symptoms, and typical patient profiles. Figure adapted from Zhou et al9 under the …