Study explores why heart failure hits some communities harder

Copied word for word from the study's registry entry, so the wording is the study team's rather than ours.

Inclusion Criteria are patients enrolled in SYMPHONY as described below: * ≥40 years old at enrollment * Willing to sign informed consent * Specific Activity Scale results that match a NYHA-FC score II-IV * Has a minimum of 2 documented risk factors for heart failure: * Established cardiovascular disease (e.g. persistent or permanent atrial fibrillation, myocardial infarction/ coronary artery disease \[coronary artery bypass grafting, percutaneous coronary intervention or documented stenosis or an epicardial coronary artery (50% LMS, \>70% LAD/Cx/RCA\], or valvular heart disease) * An established diagnosis of diabetes (type I or II) * Persistent or permanent atrial fibrillation (NOT paroxysmal atrial fibrillation) * Previous ischemic or embolic stroke * Peripheral arterial disease (previous surgical or percutaneous revascularisation or a documented stenosis \> 50% of a major peripheral arterial vessel). * Chronic kidney disease (defined as an estimated glomerular filtration rate \<60 mL/min/1.73m2 or eGFR 60-90 mL/min/1.73m2 and UACR \> 300 mg/g) * Loop diuretic use for \> 30 days (reported at any time in the 12 months prior to consent) * Chronic obstructive pulmonary disease (COPD; evidenced by one of the following; PFTs showing airway obstruction, diagnosis by respiratory physician, CT scan reporting presence of emphysema or treatment with national guideline advocated COPD therapy). Exclusion Criteria: * Inability to give informed consent; e.g., due to significant cognitive impairment, low English proficiency, inability to read, and/or inability to understand consent content or explanations provided by investigators * Previous diagnosis of HF (with any ejection fraction and due to any cause) * Receiving renal replacement therapy * Inability to travel to Cleveland Clinic for biomarker or handheld point-of-care echo with AI (receiving hospice or skilled nursing facility care). * Anyone who, in the investigators' opinion, is not suitable to participate in the trial for other reasons e.g. a diagnosis which may compromise survival over the study period; female with a history of left breast mastectomy and breast reconstruction (inability to use AI echocardiogram) or history of only 1 visit to Cleveland Clinic for medical care in any service or with any provider (reflects a lack of using Cleveland Clinic for routine medical care)