From the Guidelines
Good screening questions for heart failure should focus on identifying key symptoms, risk factors, and functional limitations, such as shortness of breath, fatigue, swelling, and ability to perform daily activities, as recommended by the American College of Cardiology and American Heart Association guidelines 1. When assessing patients for heart failure, it is essential to ask about their symptoms, including:
- Dyspnea at rest or exertion
- Orthopnea
- Paroxysmal nocturnal dyspnea
- Fatigue
- Swelling in the legs, ankles, or abdomen
- Rapid or irregular heartbeat
- Sudden weight gain from fluid retention These symptoms can be assessed using a thorough history and physical examination, as well as laboratory evaluations and diagnostic tests such as echocardiography and electrocardiogram 1. In addition to symptom assessment, it is crucial to evaluate the patient's ability to perform routine and desired activities of daily living, as well as their volume status and weight 1. Risk factor questions should cover history of heart attack, coronary artery disease, hypertension, diabetes, valve disease, congenital heart defects, cardiomyopathy, myocarditis, sleep apnea, and family history of heart failure. Lifestyle factors such as smoking, alcohol consumption, diet, and physical activity levels should also be assessed, as well as medication history, particularly cardiac medications and adherence patterns 1. By asking these comprehensive screening questions, healthcare providers can identify patients who may need further diagnostic testing and early intervention, leading to improved outcomes for patients with heart failure.
From the Research
Screening Questions for Heart Failure
To identify potential heart failure, healthcare professionals can ask patients about the following signs and symptoms:
- Sudden weight gain or loss
- Severe cough
- Low or orthostatic blood pressure
- Profound fatigue
- Decreased exercise tolerance
- Restlessness or confusion
- Irregular pulse or palpitations
- Dyspnea (shortness of breath)
- Paroxysmal nocturnal dyspnea (waking up with shortness of breath)
- Nausea or vomiting
- Diarrhea or loss of appetite
- Fainting spells 2
Atypical Signs and Symptoms
Patients in functional class IV heart failure may exhibit more atypical signs and symptoms, including:
- Severe cough
- Nausea or vomiting
- Diarrhea or loss of appetite
- Restlessness, confusion, or fainting spells These symptoms are associated with worsening functional class and hospital setting 2
Reliable Indicators of Functional Class
Profound fatigue is a more reliable indicator of functional class than dyspnea, and is associated with worsening functional class and hospital setting 2