 Introduction/Background Heart failure (HF) is a highly prevalent and complex clinical syndrome resulting from any structural or functional impairment of ventricular filling or ejection of blood [1]. HF may result from disorders of the pericardium, myocardium, valves, or great vessels as well as from certain systemic metabolic abnormalities [1]. While survival after the initial manifestation of HF has improved because of greater evidence-based treatment of risk factors and complications [6,7], the death rate remains high, with approximately 50% of HF cases dying within 5 years of initial diagnosis [7,8]. One in 9 deaths had HF mentioned on the death certificate, and HF was the underlying cause in over 60,000 deaths in 2013 [9]. There is significant financial impact associated with HF, which is likely to increase in coming decades. In 2012, the total expense related to HF nationally was estimated to be $30.7 billion, with 68% attributable to direct medical costs [4]. By 2030, the total annual expense of HF is projected to increase by almost 127% to $69.7 billion [4]. The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through society representation on expert panels. Participation by representatives from collaborating societies on the expert panel does not necessarily imply individual or society endorsement of the final document. Reprint requests to: publications@acr.org Suspected New-Onset and Known Nonacute Heart Failure HFrEF is typically found in the setting of a form of dilated cardiomyopathy, representing a large group of heterogeneous myocardial disorders characterized by ventricular dilation and depressed myocardial contractility in the absence of abnormal loading conditions (eg, hypertension or valvular disease) [1].
Suspected New Onset and Known Nonacute Heart Failure.  Introduction/Background Heart failure (HF) is a highly prevalent and complex clinical syndrome resulting from any structural or functional impairment of ventricular filling or ejection of blood [1]. HF may result from disorders of the pericardium, myocardium, valves, or great vessels as well as from certain systemic metabolic abnormalities [1]. While survival after the initial manifestation of HF has improved because of greater evidence-based treatment of risk factors and complications [6,7], the death rate remains high, with approximately 50% of HF cases dying within 5 years of initial diagnosis [7,8]. One in 9 deaths had HF mentioned on the death certificate, and HF was the underlying cause in over 60,000 deaths in 2013 [9]. There is significant financial impact associated with HF, which is likely to increase in coming decades. In 2012, the total expense related to HF nationally was estimated to be $30.7 billion, with 68% attributable to direct medical costs [4]. By 2030, the total annual expense of HF is projected to increase by almost 127% to $69.7 billion [4]. The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through society representation on expert panels. Participation by representatives from collaborating societies on the expert panel does not necessarily imply individual or society endorsement of the final document. Reprint requests to: publications@acr.org Suspected New-Onset and Known Nonacute Heart Failure HFrEF is typically found in the setting of a form of dilated cardiomyopathy, representing a large group of heterogeneous myocardial disorders characterized by ventricular dilation and depressed myocardial contractility in the absence of abnormal loading conditions (eg, hypertension or valvular disease) [1].