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    Framingham Heart Failure Diagnostic Criteria

    Diagnoses heart failure based on major and minor criteria.
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    INSTRUCTIONS

    Select minor criteria ONLY if they cannot be explained by another comorbidity, e.g. dyspnea on exertion secondary to chronic obstructive pulmonary disease.

    When to Use
    Pearls/Pitfalls
    Why Use

    Patients with signs and symptoms of heart failure (HF).

    Minor criteria should only be selected if they cannot be explained by another comorbidity, e.g. dyspnea on exertion secondary to chronic obstructive pulmonary disease.

    • Heart failure is a clinical diagnosis. The Framingham HF Diagnostic Criteria offer an acceptable set of criteria to make the diagnosis.
    • Other diagnostic criteria include the New York Heart Association (NYHA) Classification.
    Major Criteria
    Minor Criteria

    Result:

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    Next Steps
    Evidence
    Creator Insights

    Advice

    Treat patient for heart failure. Consider referral to a cardiologist.

    Formula

    Diagnosis of HF requires 2 major criteria OR 1 major and 2 minor criteria:

    Major criteria

    • Acute pulmonary edema.
    • Cardiomegaly.
    • Hepatojugular reflux.
    • Neck vein distention.
    • Paroxysmal nocturnal dyspnea or orthopnea.
    • Pulmonary rales.
    • Third heart sound (S3 gallop rhythm).
    • Weight loss >4.5 kg in 5 days in response to treatment.

    Minor criteria

    • Ankle edema.
    • Dyspnea on exertion.
    • Hepatomegaly.
    • Nocturnal cough.
    • Pleural effusion.
    • Tachycardia (HR >120)

     

    Evidence Appraisal

    The Framingham Heart Failure Diagnostic Criteria were developed in 1971 with data from the Framingham Heart Study, a long-term prospective cohort study of patients in Framingham, Massachusetts.

    Dr. William Kannel

    About the Creator

    William Kannel, MD, MPH, (d. 2011) was a professor of medicine and public health at Boston University. He was also director of the Visiting Scientist Program at the Framingham Heart Study. Dr. Kannel published hundreds of peer reviewed studies, and coined the term “risk factors”.

    To view Dr. William Kannel's publications, visit PubMed