During 1989 to 1990 and 1992 to 1993, the researchers recruited people from Maryland, North Carolina, California, and Pennsylvania for their study. These people answered questions about their medical history, heart and lung symptoms, and medications. They had physical examinations, blood tests, heart tracings, chest x-rays, and heart ultrasound tests (echocardiography). The researchers diagnosed heart failure based on symptoms, physical examination, x-rays, and medication use. The researchers used the echocardiography results to sort the older adults into groups with normal or abnormal emptying of the left side of the heart (that is, normal or abnormal left ventricular systolic function). The researchers contacted patients every 6 months for about 6 years. They reviewed medical records, hospitalizations, and death certificates. They then compared death rates among people with and without heart failure and with and without abnormal systolic function.