Prof Renate Schnabel (University Heart Center Hamburg, Hamburg, DE) discusses the importance of recognising atypical presentations of stroke and heart failure. Beyond well-known signs, patients – particularly older adults, women, and those with co-morbidities – may show subtle symptoms such as confusion, vertigo, vomiting, or loss of appetite. Early recognition is critical: stroke is always an emergency, and delayed heart failure diagnosis worsens outcomes. Prof Schnabel calls for vigilance, simple diagnostic testing and clear pathways to ensure timely evaluation and treatment.

Prof Alta Schutte (University of New South Wales, Sydney, Australia) highlights the value of home-based screening for blood pressure and atrial fibrillation. With limited time in primary care, many cases go undetected – yet validated home devices can reliably measure both conditions. Prof Schutte stresses the importance of using only clinically validated monitors, training patients in accurate measurement, and incorporating home data into routine practice. Early detection at home offers a practical, guideline-endorsed way to improve diagnosis and outcomes.

Prof Eva Gerdts (University of Bergen, Norway) explores key sex differences in cardiac structure and their impact on diagnosis. Women generally have smaller hearts and arteries, requiring sex-specific thresholds to accurately detect hypertrophy and atrial enlargement. Misinterpretation can delay recognition of early, reversible organ damage. Prof Gerdts also stresses that women’s symptoms, such as breathlessness, are often dismissed as lifestyle-related, leading to underdiagnosis. Objective testing and awareness of sex-specific differences are essential for timely cardiovascular prevention and care.

Prof Eva Gerdts (University of Bergen, Norway) underscores the importance of early blood pressure screening to prevent stroke and heart failure. Hypertension remains the leading cardiovascular risk factor, yet annual checks from age 40 – ideally with devices that also record pulse – are often overlooked. Prof Gerdts highlights that early treatment can cut stroke risk by up to 70% and substantially lower heart failure risk. She advises clinicians to take patient-reported high readings or irregular rhythms seriously, confirm with ECG and standardised blood pressure measurement, and refer promptly when needed.

In this peer-to-peer discussion, Dr Yassir Javaid (Northamptonshire, UK) and Prof Faizel Osman (University Hospitals Coventry and Warwickshire, UK) explore the challenge of missed diagnoses in atrial fibrillation, heart failure and stroke. They stress the need for opportunistic screening in primary care, as many patients are asymptomatic or misattribute symptoms.

In this second part of the discussion, Dr Yassir Javaid (Northamptonshire, UK) and Prof Faizel Osman (University Hospitals Coventry and Warwickshire, UK) consider portable and integrated devices, such as blood pressure monitors with ECG, can support earlier detection. Timely anticoagulation and early rhythm control are key to stroke prevention and better outcomes, with integrated care models helping to streamline pathways.

Dr Yassir Javaid (Northampton, UK) explains how home blood pressure and ECG monitoring can improve cardiovascular prevention. Hypertension and atrial fibrillation are common, often silent and major drivers of stroke and heart failure. Remote self-monitoring provides accurate data, speeds diagnosis and empowers patients. With proper training and timely review, integrated BP and ECG devices enable earlier detection and better outcomes.