Heart failure (HF) will affect 20% of people now aged 40 years and confers high rates of early readmission and death. Our integrated programme addressing unmet needs in HF includes: (1) The IMPERATIVE-HF controlled trial of intensified immediate post-discharge management using special blood tests to individually grade risk and guide intervention with rapid adjustments to treatment to improve outcomes. (2) Testing of candidate kidney damage markers for early warning of this frequent and dangerous complication of HF. (3) Establishing correct sampling times for novel markers for best prediction of early and long-term outcomes in HF. (4) Testing our newly discovered markers for early warning of pneumonia complicating HF. (5) Clarification of diagnoses and testing management plans for patients in the emergency department with breathlessness or chest pain who do not have clear-cut HF or heart attacks, but who nevertheless have elevated blood biomarkers and a poor outlook.