Diagnosis of heart failure depends on clinical symptoms and signs with imaging usually echocardiography - and increasingly laboratory measured biomarkers such as natriuretic peptides (chapter 5). Technological progress has led to availability of further imaging technologies e.g. cardiac magnetic resonance imaging (chapter 5) and biomarkers which might be used in diagnosis or for monitoring the efficacy and titration of therapies (chapter 8). The National Heart Failure audit highlights the roles that beta-blocker (chapter 6) and mineralocorticoid receptor antagonist (MRA) therapy (chapter 6) are playing in management of heart failure. The evidence base for these treatments has increased over the last 10 years. Despite the high prevalence of ischaemic heart disease in patients with heart failure the role of coronary intervention in patients with heart failure remains unclear (chapter 6). The high incidence of iron deficiency and anaemia in patients with heart failure has prompted trials of iron therapy in heart failure (chapter 6). Patients with co-morbidities have a worse prognosis and some co-morbidities such as atrial fibrillation (chapter 6) or chronic kidney disease can influence the management of heart failure (chapter 6). Non-pharmacological interventions also have a substantial and under-recognised role to play in the management of heart failure. Evidence has accumulated for better outcomes in patients receiving care from cardiology services including specialist heart failure nurses (chapter 9) and in those able to access rehabilitation (chapter 7). The increasing move of complex care from hospital to primary care places a greater emphasis on communication and processes for transition of care (chapter 9) and the ability to manage symptomatic relief in community settings (chapter 10). Developments in information technology and in the use of telephone-based and direct telemonitoring technologies have the potential to further improve delivery of care (chapter 8) 241 . 