Asian neTwork for Translational Research and Cardiovascular Trials ("ATTRaCT")

Heart failure (HF) is the final common pathway of cardiovascular (CV) diseases and leading cause of CV hospitalizations in Singapore and worldwide, with a mortality rate that rivals most cancers (>50% mortality at 5 years). Also similar to cancer, HF is a staged disease where early detection and treatment are vital for prevention of disease progression from Stage A (risk factors) to Stage B (subclinical structural heart disease) and Stage C (symptomatic HF). Cardiac imaging is critical for the detection of early subclinical disease. There is limited understanding of the mechanisms underlying disease progression and effective therapies are limited, particularly for the half of the HF population with preserved ejection fraction (HFPEF or "diastolic HF") for which there is no effective therapy to date (in contrast to HF with reduced ejection fraction [HFREF] or "systolic HF").

The investigators overall aim is to build on Singapore's competitive advantages in advanced cardiac imaging, genetic and molecular studies to develop an integrated "one -stop" platform spanning from human to large and small animal models, dedicated to deepening the understanding of CV disease progression, discovery of new targets and repurposing of drugs.

Inclusion criteria

• Age 21-99
• Present to hospital with diagnosis of HF, or

Attending a hospital clinic for management of HF within 6/12 of an episode of decompensated heart failure* which either:

• Resulted in a hospital admission (primary diagnosis) or
• Was treated in out-patient clinic * Appropriate symptoms and signs of HF, confirmed by PI when necessary

Exclusion criteria

• HF primary due to severe valve disease
• The primary diagnosis is an Acute coronary syndrome (ACS) which has resulted in a transient episode of Acute pulmonary oedema (APO) (Note: Patients with a troponin rise noted during the index admission, but in whom the main presentation is considered clinically to the HF will be included)
• End stage renal failure (eGFR < 15ml/min/m2) or is receiving or planned to receive renal replacement therapy.
• Other specific subgroups of HF (Including constrictive pericarditis, complex adult congenital heart disease, hypertrophic cardiomyopathy, eosinophilic myocarditis, cardiac amyloid and acute chemotherapy-induces cardiomyopathy)
• Isolated right heart failure** (combined right and left heart failure will be included). (Secondary to severe lung disease or pulmonary hypertension)
• Life threatening co-morbidity with a life expectancy of < 1 year
• Inability to provide informed consent
• The patient is unable to comply with study protocol requirements
• The patient is participating in another clinical research trial(only if that study precludes involvement in an observational study)
• The patient has declined to participate