Targeted screening for heart failure in primary care: evidence, challenges and a pathway-first approach to implementation

INTRODUCTION: Heart failure remains a leading cause of morbidity and mortality, yet diagnosis continues to occur late in routine practice, frequently during emergency hospitalization. Primary care is well positioned to detect heart failure earlier, but indiscriminate screening approaches have not delivered timely diagnosis at scale. This has prompted growing interest in targeted screening strategies while raising important practical implementation challenges. AREAS COVERED: This Special Report synthesizes the evidence and operational pathways underpinning screening for heart failure in primary care. Heart failure is a heterogeneous umbrella diagnosis, with important implications for how screening pathways are designed and scaled across its subtypes. Evidence from existing screening pathways and implementation studies is considered, from established biomarkers to newer diagnostic approaches, including machine learning-enabled tools and risk prediction models. A systematic search of PubMedMEDLINE, EMBASE, and the Cochrane Library was conducted using key terms including 'heart failure,' 'screening,' 'primary care,' and 'artificial intelligence,' encompassing publications up to January 2026. EXPERT OPINION: Implementation of any innovative technology in healthcare relies on effective pathway redesign as the primary determinant of impact. Progress will depend on targeted, risk-based screening pathways evaluated through pragmatic, implementation-aware trials to determine whether screening improves outcomes, for whom, and under what conditions.