Elderly primary care hypertension patients–who to refer for echocardiography?

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Heart failure (HF) is a complex clinical syndrome resulting from impaired diastolic and/or systolic function and clinically manifested by numerous, rather unspecific symptoms such as dyspnoea (at rest or exertion), orthopnoea, wheezing, chronic fatigue and lower extremity oedema. The prevalence of HF increases steeply with age, causing high mortality and morbidity, substantial loss in quality of life, and high health care costs [1]. For the diagnosis of HF, guidelines require, in addition to symptoms, objective evidence of cardiac dysfunction that is most commonly assessed by echocardiography. While many conditions may cause HF, the most common aetiologies are coronary artery disease (CAD) and hypertension.