Terry, age 78 years has a history of type 2 diabetes and chronic obstructive pulmonary disease (COPD). For the past few months, he has been complaining of increasing breathlessness with a productive cough, which feels worse than his usual respiratory symptoms. He has used his rescue pack and increased his blue inhaler, neither of which seemed to help. Today his breathlessness is even worse, and he feels exhausted, so he has gone to the local A&E department. The triage nurse suspects heart failure and arranges an urgent medical assessment to confirm the diagnosis.

Around 80% of people with heart failure are diagnosed in hospital. Diagnosis of heart failure in a secondary care setting is associated with: