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Review: medical history, physical examination, and routine tests are useful for diagnosing heart failure in dyspnoea

Clinical impact ratings Internal medicine IM/Ambulatory care GP/FP/Primary care Emergency medicine Cardiology

Key Words: dyspnea • heart failure, congestive • emergency service, hospital

The first 150 words of the full text of this article appear below.

METHODS
Data sources Medline (1966 to July 2005) and reference lists of relevant articles and textbooks.

Study selection and assessment English language studies that assessed the diagnostic accuracy of elements of the history, physical examination, or readily available tests in adults with undifferentiated dyspnoea presenting to the ED. The reference standard was diagnosis by a panel of physicians based on clinical signs and symptoms and an appropriate measure of cardiac dysfunction. 2 reviewers independently assessed the studies for inclusion and methodological quality.

Outcomes pooled positive and negative likelihood ratios (LRs) for HF, calculated using a random effects model.

MAIN RESULTS
22 studies met the selection criteria, but only 18 high quality studies were included. Features assessed in >1 study and found to be useful in diagnosing HF are in the table on the website (www.evidence-basedmedicine.com). Findings that were useful for ruling in and ruling out HF are summarised in the conclusions.

CONCLUSIONS
. . . [Full text of this article]

Peter C Wyer, MD

Columbia University College of Physicians and Surgeons, New York City, New York, USA