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Background The 12-lead electrocardiogram (ECG) is an essential tool for the diagnosis and management of heart failure (HF). There are few population-based studies on the prevalence and prognostic implications of ECG abnormalities in patients with HF. There are also no robust diagnostic criteria for HF. We explored these issues in a large administrative database. Methods The National Health Service Greater Glasgow and Clyde Health Board serves a population of ∼1.1 million. We obtained de-identified administrative data, including investigations, diagnosis and prescriptions, linked to hospital admissions and deaths, for anyone with a diagnosis of vascular disease or HF or prescribed loop diuretics (LD) or neuro-endocrine antagonists between 1st January 2012 and 1st April 2018. People were classified into 5 exclusive groups: a) prevalent HF; b) incident (or latent) HF with onset during follow-up; c) people taking LDs but with no diagnosis of HF at any time; d) new prescription of LDs during follow-up but with no diagnosis of HF at any time and d) people to whom none of the above applied. ECGs were classified according to heart rhythm (sinus, AF or flutter or pacemaker/CRT/ICD) and QRS duration 130ms. Follow-up for each group started on 1st of January 2012 (prior to the onset of the classifying event for incident groups). Results During the observation period, of 316,350 people included, 158,421 had a recorded ECG (mean of 3.2 per person with an ECG), including 8,768 prevalent and 13,195 incident cases of HF. Of those who never got a diagnosis of heart failure, 11,508 were receiving and a further 14,633 were newly prescribed LD during follow-up. There were 110,317 people who did not fall into the above groups, of whom 51,089 were aged ≥60 years. A higher proportion of those who were prescribed loop diuretics without a diagnosis of heart failure were women. A similar proportion of those with heart failure and those prescribed diuretics alone had, lung disease and renal dysfunction but patients with heart failure had more ischaemic heart disease, more often had a heart rhythm other than sinus and had longer QRS duration. By three years, 8,816 people (11%) had died, of whom 2,919 (33%) had a diagnosis of heart failure and 2,694 (31%) had been prescribed LD without a diagnosis of HF, together accounting for 64% of all deaths. Patients with a rhythm other than sinus had a worse prognosis in all 5 groups of patients. QRS duration >130ms was associated with a worse prognosis in patients with HF or taking LD. Conclusions Most people with cardiovascular disease who die will first develop HF or be prescribed a LD (indicating possible undiagnosed HF). Patient characteristics of those prescribed LD suggest that many might have HF with preserved left ventricular ejection fraction (HFpEF). Baseline characteristics and HR Funding Acknowledgement Type of funding source: None

This editorial refers to ‘Predicting survival in heart failure: a risk score based on 39 372 patients from 30 studies’, by S.J. Pocock et al., doi:10.1093/eurheartj/ehs337 Heart failure is now the most common condition that leads to hospital admission in industrialized nations. Although the overall prognosis for patients with chronic heart failure is still gloomy, and similar to that of many of the most common forms of cancer,1 a combination of pre-clinical and clinical research conducted over the past 25 years has led to five significant advances, each of which has received a IA recommendation in the European Society of Cardiology Guidelines for the treatment of heart failure with reduced ejection fraction.2 These advances, well known to cardiologists, are: (i) blockers of the renin–angiotensin system [angiotensin-converting enzyme (ACE) inhibitors or angiotensin II type I receptor blockers (ARBs)]; (ii) beta-adrenergic blockers; (iii) aldosterone antagonists; (iv) implantation of cardioverter-defibrillators; and (v) the application of cardiac resynchronization therapy in patients with QRS prolongation. Each has been shown to reduce mortality in patients with heart failure. As a consequence, the cumulative benefits of these therapies has improved the prognosis in these patients quite substantially.3 The development of a management plan for individual patients with heart failure (as is the case with many conditions) requires an assessment of prognosis. This has been a challenging task in patients with chronic heart failure. A number of risk scores have been established since 2003 to …

ORS duration my have an influence on the outcome of ventricular pacing, the influence of pacing site on QRS duration was investigated. Methods In 20 patients ( 5 female, 15 male) with a mean age of 61.1 years (11-93) the ventricular lead Medtronic SelectsecureTM 3830 was placed in the RVOT. Indication was SSS in 9, AV-block in 11 and AF in 1 patient. 11 leads were placed at the free wall and 9 leads at the septum of the RVOT. Measurements were taken with the Medtronic Analyzer. Results Intraoperative measurements were satisfying (Threshold 0.45 V (0.3-1.2), R-wave 10.8 mV (3.2-30), Impedance 772 Ohm (500-1721)) with no difference between free wall and septum. Total QRS duration of the intrinsic conducted QRS was 99 msec (50-160), and 139 msec of the paced QRS (100-200). The mean QRS prolongation by pacing was 40 msec (− 20 − +120). On free wall pacing site the mean prolongation was 49 msec, in septal pacing 33 msec. ![Figure][1] Conclusion RVOT pacing with the Selectsecure pacing system in feasible, the mean paced QRS duration in RVOT is 40 msec longer than the intrinsic, with shorter paced QRS at the septum, than at the free wall of the RVOT. [1]: pending:yes