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. Quality of the clinical evidence No clinical evidence was found. Trade-off between clinical benefits and harms As no randomised controlled studies were found that addressed the review question, the committee was not able to make a recommendation on the clinical and cost effectiveness of cardiac MRI in heart failure. The committee decided to make a research recommendation to establish the added value of cardiac MRI (in terms of its clinical and cost effectiveness) in the clinical pathway of heart failure, for the reasons discussed below. Trade-off between net clinical effects and costs No previously published economic evaluations were identified evaluating the cost effectiveness of cardiac MRI (followed by the appropriate patient pathway) in patients with heart failure. The cost of a cardiac MRI and echocardiography was presented to the committee ( 264 and 84 respectively); however, as there was no clinical evidence, the committee could not make a judgement on the cost- effectiveness of cardiac MRI. However, the committee agreed that due to the greater cost of cardiac MRI compared to echocardiography it was important that an assessment of the cost-effectiveness of cardiac MRI was included in the research recommendation. Other considerations The committee considered the use of cardiac MRI in heart failure to be an area of high priority for future research. 