Victorian study of Echocardiographic detection of Left ventricular dysFunction (Vic-ELF)

INTERVENTION: Patients will be randomised into two possible strategies of screening: Advanced imaging vs conventional imaging. Advanced cardiac imaging will involve inclusion of global longitudinal strain and diastolic dysfunction evaluation. The test will be performed by a qualified clinician (usually a sonographer), and the procedure will take about 30 minutes. Individuals in either imaging group who are identified as having Stage B heart failure will be treated with spironolactone as an oral tablet (25mg) daily for 12 months. Adherence to spironolactone will be monitored by tablet count from empty drug packet return. CONDITION: atrial fibrillation heart failure PRIMARY OUTCOME: New LV dysfunction, defined on the basis of 3D echo. Recognition of incident symptomatic heart failure at clinic review by a physician applying Framingham criteria.. SECONDARY OUTCOME: Change in 6 minute walk. Diagnosed atrial fibrillation from medical records and multiple daily ECG acquisitions (usually 4/day) using a handheld single‐lead monitoring device. INCLUSION CRITERIA: Aged >65 years with any of; ‐Diabetes (T2DM), based on self‐report including medical management ‐Obesity (body mass index [BMI] greater than or equal to 30) ‐High blood pressure (blood pressure greater than 140/90 mmHg, self‐reported, including anti‐hypertensive medication) ‐Known non‐ischaemic cardiac disease (but not existing heart failure)