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We aimed to develop a scalable tool to identify those at high risk of undiagnosed HF using routine electronic health records (EHR). We developed and internally validated a logistic regression (FIND-HF) model for incident HF diagnosis within one year in United Kingdom primary care EHRs (CPRD-Aurum, n=3 520 186), with good prediction performance (area under the receiver operating characteristic curve (AUC) 0.79), equal to more complex modelling techniques. We externally validated FIND-HF in United Kingdom (CPRD-GOLD, n=570 850, AUC 0.72), Japan (JMDC, n=6 820 694, AUC 0.73), United States of America (Epic Cosmos, n=7 710 398, AUC 0.78), and Taiwan (NTUH, n=170 518, AUC 0.85). In a cohort who had undergone HF diagnostics an optimised FIND-HF threshold had a positive predictive value of 21.4% and a negative predictive value of 96.9%. Amongst patients with HF who had undergone cardiac magnetic resonance imaging, high FIND-HF risk compared with low FIND-HF risk as reference, was associated with increased risk of a primary composite outcome of heart failure hospitalisation or cardiovascular death and more advanced adverse remodelling including lower left ventricular ejection fraction. FIND-HF is a scalable EHR-based model which has the potential to help rule out undiagnosed HF in low risk cases, whilst high risk cases are associated with more advanced cardiac dysfunction and worse prognosis.<\/jats:p>","DOI":"10.1038\/s41598-026-60673-w","type":"journal-article","created":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T14:53:50Z","timestamp":1783781630000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Scalable risk stratification of undiagnosed heart failure using routine health data and its association with imaging phenotypes and outcomes"],"prefix":"10.1038","volume":"16","author":[{"given":"Yoko M.","family":"Nakao","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramesh","family":"Nadarajah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farag","family":"Shuweihdi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher J.","family":"Hayward","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michihiko","family":"Goto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jung-Chi","family":"Hsu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad","family":"Haris","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ben","family":"Hurdus","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Osama","family":"Tariq","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Temar","family":"Habtezghi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Helbitz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Wahab","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lan","family":"Mu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuhiro","family":"Nakao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Swoboda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amitava","family":"Banerjee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark C.","family":"Petrie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clare J.","family":"Taylor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koji","family":"Kawakami","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianhua","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris P.","family":"Gale","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,11]]},"reference":[{"key":"60673_CR1","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.122.027852","volume":"12","author":"T Yan","year":"2023","unstructured":"Yan, T. et al. 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YMN has been employed by the Department of Digital Health and Epidemiology, an Industry-Academia Collaboration Course supported by Eisai, and Kyowa Kirin, and received research grants from the Japan Research Foundation for Healthy Aging and Bayer. MG has received grants from US Agency for Healthcare Research and Quality, US Centers for Diseases Control and Prevention, and US Department of Veterans Affairs. KN has received a research grant from the Japan Research Foundation for Healthy Aging. PS has received grants from the British Heart Foundation, National Institute of Health Research, and HRUK; fiduciary role in British Cardiovascular Society and British Society for CMR. CJT has received research funding from the National Institute for Health and Care Research and British Heart Foundation, and consultancy fees, honoraria and support to attend meetings from AstraZeneca, Bayer, Roche and Edwards outside the submitted work. KK has received research funds from AstraZeneca K.K., Eisai Co., Ltd., Kyowa Kirin Co., Ltd., OMRON Corporation, and Toppan Inc.; consulting fees from Advanced Medical Care Inc., JMDC Inc., LEBER Inc., Ubicom Holdings, Inc., Santen Pharmaceutical Co., Ltd., and Shin Nippon Biomedical Laboratories Ltd.; executive compensation from Cancer Intelligence Care Systems, Inc. and Mytreya Inc.; honoraria from Kyoto University Original Co., Ltd., Pharma Business Academy Ltd., Shionogi & Co., Ltd., Taisho Pharmaceutical Co., Ltd., and SANSHO Co., Ltd; and held stock in Real World Data Co., Ltd. CPG reports personal fees from AstraZeneca, Amgen, Bayer, Boehrinher-Ingelheim, Daiichi Sankyo, Vifor, Pharma, Menarini, Wondr Medical, Raisio Group and Oxford University Press. He has received educational and research grants from BMS, Abbott inc., the British Heart Foundation, National Institute of Health Research, Horizon 2020, and from the European Society of Cardiology, outside the submitted work. All other authors declare no competing interests, or activities that could appear to have influenced the submitted work.","order":1,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"31936"}}