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Figure 4 Diagnostic algorithm for chronic heart failure presenting in the outpatient or community setting. BNP, B-type natriuretic peptide; CXR, chest X-ray; ECG, electrocardiogram; HbA1c, glycated haemoglobin; HF, heart failure; HFpEF, heart failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection fraction; LVEF, left ventricular ejection fraction; NT-proBNP, N-terminal pro-B-type natriuretic peptide; POCUS, point-of-care ultrasound; TSAT, transferrin saturation; UACR, urine albumin-to-creatinine ratio. aFull blood count, kidney function, electrolytes, UACR, liver function, thyroid function, HbA1c, lipids, and iron status (TSAT and ferritin). bExamination by POCUS may aid in diagnosis although echocardiography is recommended. cNatriuretic peptides may be false low in certain settings (Table 9). dPreferable performed within 2 weeks if NT-proBNP >2000 pg/mL. Downloaded from academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehag100/8766302 by guest on 31 August 2026