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Congestive Heart Failure: Sensitivity and Specificity

Introduction: Most of the discussion here refers to decreased LV systolic function. Some studies evaluated symptomatic - or decompensated - heart failure, while others included asymptomatic patients.

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Tags: Cardiac Problem Tag this Diagnosis.

The sensitivity and specificity of findings for Congestive Heart Failure are listed below. See the left navigation bar to change the display.

Specific Findings

Finding SensitivitySpecificity Comments, Study
S3
Duplicate Edit
13%99%

in dyspneic patients presenting to the ED

Study: JAMA. 2005 Oct 19;294(15):1944-56 PMID: 16234501

Dyspnea on Exertion
Duplicate Edit
15%97%

population is elderly patients in primary care setting. Standard is echo for decreased systolic function.

Study: BMJ. 1999 Feb 6;318(7180):368-72. PMID 9933201

Elevated JVP Edit 11%97%

population is elderly patients in primary care setting. Standard is echo for decreased systolic function.

Study: BMJ. 1999 Feb 6;318(7180):368-72. PMID 9933201

Rather similar results in JAMA. 2005 Oct 19;294(15):1944-56 PMID: 16234501

Ascites Edit 1%97%

in dyspneic patients presenting to the ED

Study: JAMA. 2005 Oct 19;294(15):1944-56 PMID: 16234501

Abdominojugular Reflux Edit 24%96%

in dyspneic patients presenting to the ED

Study: JAMA. 2005 Oct 19;294(15):1944-56 PMID: 16234501

Chest X-Ray Edit 71%92%

for patients presenting to ED with dyspnea. Standard is decreased LV systolic function.

Study: BMJ. 1997 Mar 29;314(7085):936-40. PMID 9099117

History of MI Edit 39%91%

population is elderly patients in primary care setting. Standard is echo for decreased systolic function.

Study: BMJ. 1999 Feb 6;318(7180):368-72. PMID 9933201

Rather similar results in JAMA. 2005 Oct 19;294(15):1944-56 PMID: 16234501

Peripheral Edema
Duplicate Edit
18%91%

population is elderly patients in primary care setting. Standard is echo for decreased systolic function.

Study: BMJ. 1999 Feb 6;318(7180):368-72. PMID 9933201

S3
Duplicate Edit
52%87%

by reduced EF

Study: JAMA 2005 May 11;293(18):2238-44. PMID 15886379

Clinical diagnosis
Duplicate Edit
61%86%

"initial judgment"

in dyspneic patients presenting to the ED

Study: JAMA. 2005 Oct 19;294(15):1944-56 PMID: 16234501

Sensitive Findings

Finding SensitivitySpecificity Comments, Study
ECG Edit 98%69%

for patients presenting to ED with dyspnea. Standard is decreased LV systolic function.

Study: BMJ. 1997 Mar 29;314(7085):936-40. PMID 9099117

BNP Edit 90%76%

For pts presenting with dyspnea not due to tamponade, trauma, AMI, ARF. BNP cutoff of 100pg/mL.

Study: NEJM. 2002 Jul 18;347(3):161-167. PMID 12124404

Negative Findings

Finding SensitivitySpecificity Comments, Study
Ascites Edit 1%97%

in dyspneic patients presenting to the ED

Study: JAMA. 2005 Oct 19;294(15):1944-56 PMID: 16234501

Cough Edit 36%61%

in dyspneic patients presenting to the ED

Study: JAMA. 2005 Oct 19;294(15):1944-56 PMID: 16234501

Wheezing Edit 22%58%

in dyspneic patients presenting to the ED

Study: JAMA. 2005 Oct 19;294(15):1944-56 PMID: 16234501

Poorly Diagnostic Findings

Finding SensitivitySpecificity Comments, Study
History of Angina Edit 48%84%

population is elderly patients in primary care setting. Standard is echo for decreased systolic function.

Study: BMJ. 1999 Feb 6;318(7180):368-72. PMID 9933201

Paroxsymal Nocturnal Dyspnea Edit 41%84%

in dyspneic patients presenting to the ED

Study: JAMA. 2005 Oct 19;294(15):1944-56 PMID: 16234501

Crackles Edit 44%82%

crackles at the lung bases

population is elderly patients in primary care setting. Standard is echo for decreased systolic function.

In a study looking at patients undergoing echo for peripheral edema, crackles had a 24% sensitivity and 98% specificity for a cardiac origin of the edema (Clin Cardiol. 2006 Jan;29(1):31-5. PMID: 16477775).

Study: BMJ. 1999 Feb 6;318(7180):368-72. PMID 9933201

Rather similar results in JAMA. 2005 Oct 19;294(15):1944-56 PMID: 16234501

Peripheral Edema
Duplicate Edit
50%78%

in dyspneic patients presenting to the ED

Study: JAMA. 2005 Oct 19;294(15):1944-56 PMID: 16234501

Orthopnea Edit 50%77%

in dyspneic patients presenting to the ED

Study: JAMA. 2005 Oct 19;294(15):1944-56 PMID: 16234501

S4 Edit 43%72%

for reduced EF

Study: JAMA 2005 May 11;293(18):2238-44. PMID 15886379

Rather similar results in JAMA. 2005 Oct 19;294(15):1944-56 PMID: 16234501

Fatigue and Weight Gain Edit 31%70%

in dyspneic patients presenting to the ED

Study: JAMA. 2005 Oct 19;294(15):1944-56 PMID: 16234501

Clinical diagnosis
Duplicate Edit
81%47%

in patients presenting to the ED with dyspnea. Standard is decreased LV systolic function.

Study: BMJ. 1997 Mar 29;314(7085):936-40. PMID 9099117

Dyspnea on Exertion
Duplicate Edit
84%34%

dyspneic patients presenting to the ED

Study: JAMA. 2005 Oct 19;294(15):1944-56 PMID: 16234501

Findings With Unspecified Accuracy

Finding SensitivitySpecificity Comments, Study
Tachycardia Edit No accuracy specified.

Heart Rate > 100

Study: Unknown

Pulsus Alternans Edit No accuracy specified.

From UpToDate:

virtually pathognomonic of severe left ventricular failure

characterized by evenly spaced alternating strong and weak peripheral pulses. It is best appreciated by applying light pressure on the peripheral arterial pulse, and can be confirmed by measuring the blood pressure. When the cuff pressure is slowly released, phase I Korotkoff sounds are initially heard only during the alternate strong beats; with further release of cuff pressure, the softer sounds of the weak beat also appear. The degree of pulsus alternans can be quantitated by measuring the difference in systolic pressure between the strong and the weak beat.

Study: Examination of the arterial pulse article in UpToDate