Two systematic reviews have assessed the diagnostic accuracy of elements of the medical history, physical examination, or readily available tests in diagnosing HF in adults with undifferentiated dyspnea:
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Many features increased the probability of heart failure, with the best feature for each category being the presence of:
(1) the chest radiograph showing pulmonary venous congestion (positive LR = 12.0; 95% CI, 6.8-21.0);
(2) the sign of the third heart sound (S3) gallop (positive LR = 11; 95% CI, 4.9-25.0);
(3) past history of heart failure (positive LR = 5.8; 95% confidence interval [CI], 4.1-8.0);
(4) electrocardiogram showing atrial fibrillation (positive LR = 3.8; 95% CI, 1.7-8.8).
(5) the symptom of paroxysmal nocturnal dyspnea (positive LR = 2.6; 95% CI, 1.5-4.5);
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Conversely, findings useful in excluding HF include, in decreasing order:
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A low serum BNP proved to be the most useful test (serum B-type natriuretic peptide <100 pg/mL; negative LR = 0.11; 95% CI, 0.07-0.16).
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The chest radiograph not showing cardiomegaly (negative LR = 0.33; 95% CI, 0.23-0.48);
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The absence of a past history of heart failure (negative LR = 0.45; 95% CI, 0.38-0.53);
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The absence of symptom of dyspnea on exertion (negative LR = 0.48; 95% CI, 0.35-0.67);
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No Rales (negative LR = 0.51; 95% CI, 0.37-0.70)
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Lack of Any electrocardiogram abnormality (negative LR = 0.64; 95% CI, 0.47-0.88).
REFERENCES:
- Wang CS, FitzGerald JM, Schulzer M, Mak E, Ayas NT. Does This Dyspneic Patient in the Emergency Department Have Congestive Heart Failure? JAMA. 2005;294(15):1944–1956.