Emergency diagnosis of congestive heart failure: impact of signs and symptoms. Export

@article{citeulike:563939, abstract = {BACKGROUND: The most useful features in the diagnosis of congestive heart failure (CHF) have been poorly investigated. OBJECTIVE: To determine the utility of signs and symptoms in the diagnosis of CHF in the emergency department. METHODS: Detailed clinical data were collected prospectively from 452 consecutive patients presenting with acute dyspnea to the emergency department. By using logistic regression analysis, significant predictors for the final discharge diagnosis of CHF (adjudicated after review of all patient records, including response to therapy) were assessed. RESULTS: In 217 of 452 patients (48\%), CHF was the cause of acute dyspnea. Among symptoms, the OR for CHF was highest for weight gain (OR 3.6; 95\% CI 1.9 to 7.0), nocturia (OR 2.4; 95\% CI 1.6 to 3.7) and paroxysmal nocturnal dyspnea (OR 2.4; 95\% CI 1.6 to 3.5), and lowest for fever (OR 0.36; 95\% CI 0.22 to 0.56). Among signs, the OR was highest for elevated jugular venous pressure (OR 4.3; 95\% CI 2.3 to 7.9), rales (OR 3.1; 95\% CI 2.1 to 4.5), lower extremity edema (OR 2.8; 95\% CI 1.9 to 4.3) and hepatojugular reflux (OR 2.7; 95\% CI 1.4 to 5.2), and lowest for wheezing (OR 0.38; 95\% CI 0.24 to 0.61). The overall sensitivity was low. The specificity was highest for elevated jugular venous pressure and hepatojugular reflux. CONCLUSIONS: Signs and symptoms are only moderately helpful in the diagnosis of CHF in patients with acute dyspnea. This emphasizes the need for additional diagnostic tools, such as echocardiography or B-type natriuretic peptide testing.}, address = {University of Basel, University Hospital, Department of Internal Medicine, Basel, Switzerland. chmueller@uhbs.ch}, author = {Mueller, C. and Frana, B. and Rodriguez, D. and Laule-Kilian, K. and Perruchoud, A. P.}, citeulike-article-id = {563939}, citeulike-linkout-0 = {http://view.ncbi.nlm.nih.gov/pubmed/16239975}, citeulike-linkout-1 = {http://www.hubmed.org/display.cgi?uids=16239975}, issn = {0828-282X}, journal = {Can J Cardiol}, keywords = {cardiology, family\_practice}, month = {September}, number = {11}, pages = {921--924}, posted-at = {2006-03-26 14:04:57}, priority = {2}, title = {Emergency diagnosis of congestive heart failure: impact of signs and symptoms.}, url = {http://view.ncbi.nlm.nih.gov/pubmed/16239975}, volume = {21}, year = {2005} }

TY - JOUR ID - citeulike:563939 L3 - citeulike-article-id:563939 N2 - BACKGROUND: The most useful features in the diagnosis of congestive heart failure (CHF) have been poorly investigated. OBJECTIVE: To determine the utility of signs and symptoms in the diagnosis of CHF in the emergency department. METHODS: Detailed clinical data were collected prospectively from 452 consecutive patients presenting with acute dyspnea to the emergency department. By using logistic regression analysis, significant predictors for the final discharge diagnosis of CHF (adjudicated after review of all patient records, including response to therapy) were assessed. RESULTS: In 217 of 452 patients (48%), CHF was the cause of acute dyspnea. Among symptoms, the OR for CHF was highest for weight gain (OR 3.6; 95% CI 1.9 to 7.0), nocturia (OR 2.4; 95% CI 1.6 to 3.7) and paroxysmal nocturnal dyspnea (OR 2.4; 95% CI 1.6 to 3.5), and lowest for fever (OR 0.36; 95% CI 0.22 to 0.56). Among signs, the OR was highest for elevated jugular venous pressure (OR 4.3; 95% CI 2.3 to 7.9), rales (OR 3.1; 95% CI 2.1 to 4.5), lower extremity edema (OR 2.8; 95% CI 1.9 to 4.3) and hepatojugular reflux (OR 2.7; 95% CI 1.4 to 5.2), and lowest for wheezing (OR 0.38; 95% CI 0.24 to 0.61). The overall sensitivity was low. The specificity was highest for elevated jugular venous pressure and hepatojugular reflux. CONCLUSIONS: Signs and symptoms are only moderately helpful in the diagnosis of CHF in patients with acute dyspnea. This emphasizes the need for additional diagnostic tools, such as echocardiography or B-type natriuretic peptide testing. IS - 11 JF - Can J Cardiol SN - 0828-282X AD - University of Basel, University Hospital, Department of Internal Medicine, Basel, Switzerland. chmueller@uhbs.ch EP - 924 TI - Emergency diagnosis of congestive heart failure: impact of signs and symptoms. VL - 21 SP - 921 KW - cardiology KW - family_practice AU - Mueller, C AU - Frana, B AU - Rodriguez, D AU - Laule-Kilian, K AU - Perruchoud, AP PY - 2005/09// UR - http://view.ncbi.nlm.nih.gov/pubmed/16239975 ER -