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

(Retired) Clinical Director Primary Care, VHA Medical CenterProfessor Emeritus Oregon Health & Sciences UniversityPortland, Oregon, USA

Key Words: dyspnoea • heart failure (congestive) • emergency service (hospital)

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

I read with interest the commentary provided by Dr Wyer regarding the value of dyspnoea on exertion in congestive heart failure (HF).¹ The data reveal the pooled positive likelihood ratio (+LR) for dyspnoea on exertion to be 1.3 and the negative likelihood ratio (–LR) to be 0.48. He states, "Surprisingly, the presence of dyspnoea on exertion has little effect on raising the likelihood of HF, although as expected, its absence lowers HF likelihood." I concur that dyspnoea on exertion is not useful in raising the probability for HF considering the low +LR, but I disagree that the absence of dyspnoea on exertion lowers the likelihood of HF below a threshold probability where neither treatment nor further diagnostic intervention is warranted. If hypothetical pretest probabilities for HF are 0.60, 0.40, and 0.20, the post-test probabilities for a negative test (lack of dyspnoea on exertion) would decrease only to 0.42, 0.24, and . . . [Full text of this article]

Peter Wyer, MD²

² Columbia University College of Physicians and SurgeonsNew York, New York, USA