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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Prevalence

Population / Calculator	Prevalence	Comments / Study / Link
46000	2.3%
1000	1%
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The sensitivity and specificity of findings for Congestive Heart Failure are listed below. See the left navigation bar to change the display.

Pre-Test Probability (Prevalence): %.	Post-Test Probability (Predictive Value): %.	Switch to display mode.
Note that calculating probabilities from more than one** finding is inherently inaccurate because findings are not independent. (For example, using two positive findings that share a common pathogenesis is likely to overestimate the true probability.)

Sensitive Findings
Finding	Result	Sensitivity	Specificity
[ + ] ECG	+ 0 -	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
[ + ] pro BNP	+ 0 -	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	Result	Sensitivity	Specificity
[ + ] Ascites	+ 0 -	1%	97%
in dyspneic patients presenting to the ED Study: JAMA. 2005 Oct 19;294(15):1944-56 PMID: 16234501
[ + ] Cough	+ 0 -	36%	61%
in dyspneic patients presenting to the ED Study: JAMA. 2005 Oct 19;294(15):1944-56 PMID: 16234501
[ + ] Wheezing	+ 0 -	22%	58%
in dyspneic patients presenting to the ED Study: JAMA. 2005 Oct 19;294(15):1944-56 PMID: 16234501

Findings With Unspecified Accuracy
Finding	Result	Sensitivity	Specificity
[ + ] Tachycardia		No accuracy specified.
Heart Rate > 100 Study: Unknown
[ + ] Crackles		No accuracy specified.
Study: no study specified.
[ + ] Pulsus Alternans		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
[ + ] Dyspnea		No accuracy specified.
Study: no study specified.
[ + ] Ankle Swelling		No accuracy specified.
Study: no study specified.
[ + ] Purulent Sputum		No accuracy specified.
Study: no study specified.
[ + ] Chest X-Ray		No accuracy specified.
Study: no study specified.
[ + ] Chest CT		No accuracy specified.
Study: no study specified.
[ + ] ECG		No accuracy specified.
Study: no study specified.
[ + ] Arterial Blood Gas		No accuracy specified.
Study: no study specified.
[ + ] Elevated CRP		No accuracy specified.
Study: no study specified.
[ + ] Elevated D-dimer		No accuracy specified.
Study: no study specified.

Specific Findings
Finding	Result	Sensitivity	Specificity
[ + ] S3	+ 0 -	13%	99%
in dyspneic patients presenting to the ED Study: JAMA. 2005 Oct 19;294(15):1944-56 PMID: 16234501
[ + ] Dyspnea on Exertion	+ 0 -	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	+ 0 -	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	+ 0 -	1%	97%
in dyspneic patients presenting to the ED Study: JAMA. 2005 Oct 19;294(15):1944-56 PMID: 16234501
[ + ] Abdominojugular Reflux	+ 0 -	24%	96%
in dyspneic patients presenting to the ED Study: JAMA. 2005 Oct 19;294(15):1944-56 PMID: 16234501
[ + ] Chest X-Ray	+ 0 -	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	+ 0 -	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	+ 0 -	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	+ 0 -	52%	87%
by reduced EF Study: JAMA 2005 May 11;293(18):2238-44. PMID 15886379
[ + ] Clinical diagnosis	+ 0 -	61%	86%
"initial judgment" in dyspneic patients presenting to the ED Study: JAMA. 2005 Oct 19;294(15):1944-56 PMID: 16234501

Poorly Diagnostic Findings
Finding	Result	Sensitivity	Specificity
[ + ] History of Angina	+ 0 -	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	+ 0 -	41%	84%
in dyspneic patients presenting to the ED Study: JAMA. 2005 Oct 19;294(15):1944-56 PMID: 16234501
[ + ] Crackles	+ 0 -	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	+ 0 -	50%	78%
in dyspneic patients presenting to the ED Study: JAMA. 2005 Oct 19;294(15):1944-56 PMID: 16234501
[ + ] Orthopnea	+ 0 -	50%	77%
in dyspneic patients presenting to the ED Study: JAMA. 2005 Oct 19;294(15):1944-56 PMID: 16234501
[ + ] S4	+ 0 -	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	+ 0 -	31%	70%
in dyspneic patients presenting to the ED Study: JAMA. 2005 Oct 19;294(15):1944-56 PMID: 16234501
[ + ] Clinical diagnosis	+ 0 -	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	+ 0 -	84%	34%
dyspneic patients presenting to the ED Study: JAMA. 2005 Oct 19;294(15):1944-56 PMID: 16234501