What are the relative values of different outcomes when diagnosing heart failure?
The committee considered the following outcomes to be critical for this review: all-cause mortality, quality of life, and all-cause hospitalisation. Data on all-cause mortality and hospitalisation were considered preferable to data limited to heart-failure related mortality and hospitalisations, primarily for consistency of methodology across the guideline, but also to take into account the potential adverse events associated with cardiac MRI or echocardiography. Adverse events related to the use of gadolinium in cardiac MRI specifically non-specific fibrosis in the presence of renal dysfunction were considered to be important for decision-making. Given the nature of the review, namely to establish whether there was any benefit in using an additional diagnostic test, the committee also specified the following process outcomes as important for decision making: reclassification of specific heart failure aetiology, change in management, change in heart failure medication, advanced therapy use, and the need for repeat or additional testing.