Most guidelines agree on three essential stages of care for patients with heart failure:

-Diagnosis (should be timely and accurate);

-Treatment (should be appropriate to each patient and available urgently if necessary);

-Longterm management (should include follow-up, monitoring and support).

Disagreement is observed on which diagnostic tools should be used for all patients with suspected heart failure and in which order.

Especially for invasive diagnostics there are some differences and challenges according to the interpretation of the diagnostic and prognostic value {45}

The Global heart failure Awareness Programme {45} reported that many guidelines have been published [North America (Canada: CCS and USA: ACCF/AHA, HFSA), Europe (England and Wales: NICE, France: HAS, Germany: DEGAM, Scotland: SIGN) and Aia (Japan: JSC, Singapore: MoH) for heart failure patients and although they may differ in what evidence is included and how it is assessed and in what is considered appropriate, the all agree on three essential stages of care for patients with heart failure: diagnosis (should be timely and accurate)-treatment (should be appropriate to each patient and available urgently if necessary)-longterm management (should include follow-up, monitoring and support. They state that an international consensus recommendation leading to greater clarity about best practice with endorsement from credible local bodies would be of help. Although published guidelines agree on which diagnostic tools are useful, they disagree on which should be used for all patients with suspected heart failure and in which order. Making an accurate diagnosis requires a range of diagnostic tools, in conjunction with clinical judgement and expert knowledge.

The ESC guidelines {77} highlight particular challenges related to diagnosis of HF-PEF (heart failure with ‘preserved’ ejection fraction) remains a particular challenge, and the optimum approach incorporating symptoms, signs, imaging, biomarkers, and other investigations is uncertain. The following questions are posed: Strain/speckle imaging—value in diagnostic and prognostic assessment of both HF-REF (heart failure with reduced ejection fraction) and HF-PEF? Diastolic stress test—value in diagnosis of HF-PEF?

A recent Australian consensus statement {88} recognizes that many individuals are not diagnosed in a timely manner, and once a diagnosis is made, treatment is frequently sub-optimal.