Congestive Heart Failure: Likelihood Ratios

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 likelihood ratios 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.)

Blood Test
Finding	Result	+LR	-LR
[ + ] Elevated CRP		No accuracy specified.
Study: no study specified.
[ + ] Elevated D-dimer		No accuracy specified.
Study: no study specified.
[ + ] pro BNP	+ 0 -	3.8	0.1
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

Combination of Tests
Finding	Result	+LR	-LR
[ + ] Clinical diagnosis	+ 0 -	1.5	0.4
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
[ + ] Clinical diagnosis	+ 0 -	4.4	0.5
"initial judgment" in dyspneic patients presenting to the ED Study: JAMA. 2005 Oct 19;294(15):1944-56 PMID: 16234501

Electronic Monitor
Finding	Result	+LR	-LR
[ + ] ECG	+ 0 -	3.2	0
for patients presenting to ED with dyspnea. Standard is decreased LV systolic function. Study: BMJ. 1997 Mar 29;314(7085):936-40. PMID 9099117
[ + ] ECG		No accuracy specified.
Study: no study specified.
[ + ] Tachycardia		No accuracy specified.
Heart Rate > 100 Study: Unknown

Endocrine
Finding	Result	+LR	-LR
[ + ] Crackles		No accuracy specified.
Study: no study specified.
[ + ] Crackles	+ 0 -	2.4	0.7
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

Imaging
Finding	Result	+LR	-LR
[ + ] Chest X-Ray	+ 0 -	8.9	0.3
for patients presenting to ED with dyspnea. Standard is decreased LV systolic function. Study: BMJ. 1997 Mar 29;314(7085):936-40. PMID 9099117
[ + ] Chest X-Ray		No accuracy specified.
Study: no study specified.

Neoplasm
Finding	Result	+LR	-LR
[ + ] Crackles		No accuracy specified.
Study: no study specified.
[ + ] Crackles	+ 0 -	2.4	0.7
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

Vital Signs
Finding	Result	+LR	-LR
[ + ] Tachycardia		No accuracy specified.
Heart Rate > 100 Study: Unknown