From the Guidelines
Heart failure is diagnosed using a combination of clinical symptoms, physical examination findings, and diagnostic tests, with key criteria including symptoms such as dyspnea, fatigue, and fluid retention, and objective evidence of cardiac dysfunction, as outlined in the 2016 ESC guidelines 1. The diagnostic criteria for heart failure (HF) include:
- Symptoms such as shortness of breath (dyspnea), fatigue, and fluid retention
- Signs like elevated jugular venous pressure, pulmonary crackles, and peripheral edema
- Objective evidence of cardiac dysfunction, including:
- Echocardiography showing reduced ejection fraction (HFrEF, <40%), preserved ejection fraction with diastolic dysfunction (HFpEF, ≥50%), or mid-range ejection fraction (HFmrEF, 40-49%)
- Laboratory tests, particularly elevated B-type natriuretic peptide (BNP >100 pg/mL) or N-terminal pro-BNP (NT-proBNP >300 pg/mL)
- Chest X-rays showing cardiomegaly or pulmonary congestion
- Electrocardiograms revealing underlying rhythm disturbances or evidence of prior myocardial infarction The New York Heart Association (NYHA) classification system (Classes I-IV) is commonly used to categorize the severity based on how symptoms limit physical activity, as noted in the 2014 ACCF and AHA guidelines 1. A careful history and physical examination are essential in diagnosing HF, and initial laboratory evaluation should include a complete blood count, urinalysis, fasting lipid profile, liver function testing, and measurement of serum electrolytes, as recommended in the 2011 NICE guideline 1. The 2009 focused update incorporated into the ACC/aha 2005 guidelines for the diagnosis and management of heart failure in adults also emphasizes the importance of measuring natriuretic peptides (BNP and NT-proBNP) in the evaluation of patients presenting in the urgent care setting in whom the clinical diagnosis of HF is uncertain 1. The 2015 ACC/AHA key data elements and definitions for cardiovascular endpoint events in clinical trials provide additional details on the diagnosis of HF, including the definition of a Heart Failure Event, which includes hospitalization for HF and may include urgent, unscheduled outpatient office/practice or ED visits 1.
From the Research
Diagnostic Criteria for Heart Failure (HF)
The diagnostic criteria for heart failure (HF) involve a comprehensive evaluation, including:
- A focused history and physical examination to identify signs and symptoms of HF, such as dyspnea, fatigue, and volume overload 2, 3
- Diagnostic tools, including:
- Chest radiograph to assess for venous congestion or interstitial edema 2, 3
- Electrocardiogram to evaluate for cardiac dysfunction 2, 3
- Echocardiogram to confirm systolic or diastolic heart failure and assess left ventricular ejection fraction 2, 3
- Laboratory tests, such as complete blood count, blood glucose measurement, liver function tests, and serum electrolyte measurements 2
- Biomarkers, including B-type natriuretic peptide (BNP) and N-terminal pro B-type natriuretic peptide (NT-proBNP), which can be used as diagnostic, managing, and prognostic tools for HF 4
Clinical Assessment of Heart Failure
The clinical assessment of heart failure involves evaluating the patient's symptoms, signs, and daily weights to determine the severity of HF and guide therapy 5. The presence of certain signs and symptoms, such as a displaced cardiac apex, a third heart sound, and chest radiography findings of venous congestion or interstitial edema, can be useful in identifying heart failure 3. Additionally, the Framingham criteria and BNP levels can be used to help diagnose systolic heart failure 3.
Evaluation for Ischemic Heart Disease
Evaluation for ischemic heart disease is warranted in patients with heart failure, especially if angina is present, given that coronary artery disease is the most common cause of heart failure 3.