Notification Of High-Risk Veterans for Access to Heart Failure Prevention

The purpose of this study is to learn whether connecting people at high risk for developing heart failure to a heart doctor (cardiologist) leads to greater use of treatments that can lower that risk. Heart failure is a condition in which the heart cannot pump blood as well as it should. The study focuses on Veterans living in rural areas, who often have a higher risk of heart failure and less access to heart care. The study team will use health record information to find Veterans who are at high risk for heart failure but do not yet have it, and who have health factors that could be improved with preventive treatment. The study team expects that telling these Veterans and their primary care providers about the elevated risk, and offering early cardiology care, will lead to greater use of treatments known to help prevent heart failure compared with usual care. The main questions the study aims to answer are: * Does informing a Veteran and their primary care provider about the Veteran's elevated risk for heart failure, and offering a referral to a cardiologist, increase the use of treatments known to help prevent heart failure? * Does having a care navigator reach out to Veterans and their primary care providers further help connect these Veterans to preventive care? Veterans in the study will be placed by chance into one of three groups. One group will receive usual care. A second group, along with their primary care provider, will be told about the Veteran's elevated risk for heart failure and offered a referral to a cardiologist. A third group will receive that same information and referral offer, plus outreach from a care navigator who can explain more about heart failure and the reason for the referral, answer questions, and help with scheduling.

Inclusion Criteria: * Age 30-79 years * Receive primary care at Veterans Affairs (VA) medical centers in the VA region including Northern and Central California, Nevada, Hawaii, and the Pacific Islands with at least 1 primary care visit in the prior 2 years * Live in a rural location defined using established VA definitions of Rural-Urban Commuting Area (RUCA) codes \>1.1 - \