Aging Clinical and Experimental Research

, Volume 10, Issue 1, pp 39–47 | Cite as

Development and validation of a Clinical History Form for the diagnosis of congestive heart failure

  • D. Acanfora
  • L. Trojano
  • S. Maggi
  • G. Furgi
  • C. Rengo
  • G. L. Iannuzzi
  • A. Papa
  • F. Rengo
Original Article


Our aim was to develop and validate a new diagnostic tool for congestive heart failure (CHF) based only on clinical examination, medical history and current drug use. In the developmental phase, we enrolled 520 consecutive patients with heart disease of different etiology; the diagnosis of CHF was made by means of Smith’s clinical and radiological criteria, and the Boston criteria, with a substantial interscale agreement (kappa =0.89). The initial version of our Form included 37 items on clinical examination, medical history and drug use information. After an item reduction process, the final version of the Clinical History Form (CH Form) included 15 items, each with a score 1 to 4. The CH Form score showed a progressive, significant increase as NYHA Class increased. With a cut-off of 4 points, sensitivity was 88.6% and specificity 86.8% against Smith’s criteria for diagnosis of CHF. Substantial interrater agreement was observed for all the 15 items (kappa >0.6) on a subsample of 250 patients. In the validation phase, we studied an independent sample of 72 patients with heart disease. The CH Form was significantly correlated with left ventricular ejection fraction (r=0.42; p<0.0005) and peak oxygen consumption (r=0.69; p<0.0001). In the 64 (89%) patients who underwent non-emergent right-heart catheterization, the CH Form score was significantly correlated with pulmonary capillary wedge pressure (r=0.84; p<0.0001). The CH Form may represent a useful instrument for the diagnosis of CHF.

Key words

Congestive heart failure diagnostic tool reliability 


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  1. 1.
    Marantz P.R., Tobin J.N., Wassertheil-Smoller S., Steingart R.M., Wexler J.P., Budner N., Lense L., Wachspress J.: The relationship between left ventricular systolic function and congestive heart failure diagnosed by clinical criteria. Circulation 77: 607–612, 1988.PubMedCrossRefGoogle Scholar
  2. 2.
    Stevenson L.W., Perloff J.K.: The limited reliability of physical signs for estimating chronic heart failure. JAMA 261: 884–888, 1989.PubMedCrossRefGoogle Scholar
  3. 3.
    McKee P.A., Castelli W.P., McNamara P.M., Kannel W.B.: The natural history of congestive heart failure: The Framingham study. N. Engl. J. Med. 285: 1441–1446, 1971.PubMedCrossRefGoogle Scholar
  4. 4.
    Harlan W.R., Oberman A., Grimm R., Rosati R.: Chronic congestive heart failure in coronary artery disease: clinical criteria. Ann. Intern. Med. 86: 133–138, 1977.PubMedCrossRefGoogle Scholar
  5. 5.
    Carlson K.J., Lee D.C-S., Goroll A.H., Leahy M., Johnson R.: An analysis of physicians reasons for prescribing long-term digitalis therapy in outpatients. J. Chronic Dis. 38: 733–739, 1985.PubMedCrossRefGoogle Scholar
  6. 6.
    Battler A., Karliner J.S., Higgins C.B., Slutsky R., Gilpin E.A., Froelicher V.F., Ross J.: The initial chest X-ray in acute myocardial infarction. Prediction of early and late mortality and survival. Circulation 61: 1004–1009, 1988.CrossRefGoogle Scholar
  7. 7.
    Smith S.C. Jr., Gilpin E., Ahnve S., Dittrich H., Nicod P., Henning H., Ross J. Jr.: Outlook after acute myocardial infarction in the very elderly compared with that in patients aged 65 to 75 years. J. Am. Coll. Cardiol. 16: 784–792, 1990.PubMedCrossRefGoogle Scholar
  8. 8.
    The Criteria Committee of the New York Heart Association, Inc: Diseases of the Heart and Blood Vessels; Nomenclature and Criteria for Diagnosis, ed. 6. Little & Brown, Boston, 1964.Google Scholar
  9. 9.
    Guidelines for the evaluation and management of heart failure. Report of the American College of Cardiology/American Heart Association task force on practice guidelines (Committee on evaluation and management of heart failure). J. Am. Coll. Cardiol. 26: 1376–1398, 1995.Google Scholar
  10. 10.
    The Task Force on Heart Failure of the European Society of Cardiology. Guidelines for the diagnosis of heart failure. Eur. Heart J. 16: 741–751, 1995.Google Scholar
  11. 11.
    Gibson T.C., White K.L., Klainer L.M.: The prevalence of congestive heart failure in two rural communities. J. Chronic Dis. 19: 141–152, 1966.PubMedCrossRefGoogle Scholar
  12. 12.
    Sutton G.C.: Epidemiologic aspects of heart failure. Am. Heart. J. 120: 1538–1540, 1990.PubMedCrossRefGoogle Scholar
  13. 13.
    Schocken D.D., Arrieta M.I., Leavertone P.E., Ross E.A.: Prevalence and mortality of congestive heart failure in the United States. J. Am. Coll. Cardiol. 20: 301–306, 1992.PubMedCrossRefGoogle Scholar
  14. 14.
    Eriksson H., Caidhal K., Larsson B., Ohlson L.O., Welin L., Tibblin G., Wilhelmsen L.: Cardiac and pulmonary causes of dyspnoea. Validation of a scoring test for clinical-epidemiological use: The study of men born in 1913. Eur. Heart J. 8: 1007–1014, 1987.PubMedGoogle Scholar
  15. 15.
    Eriksson H., Svärdsudd K., Larsson B., Ohlson L.O., Welin L., Tibblin G., Wilhelmsen L.: Dyspnoea in a cross-sectional and a longitudinal study of middle-aged men: The study of men born in 1913 and 1923. Eur. Heart J. 8: 1015–1023, 1987.PubMedGoogle Scholar
  16. 16.
    Marantz P.R., Kaplan M.C., Alderman M.H.: Clinical diagnosis of congestive heart failure in patients with acute dyspnea. Chest 97: 776–781, 1990.PubMedCrossRefGoogle Scholar
  17. 17.
    Goldman L., Hasmimoto B., Cook F., Loscalzo A.: Comparative reproducibility and validity of systems for assessing cardiovascular functional class: Advantages of a new specific activity scale. Circulation 64: 1227–1234, 1981.PubMedCrossRefGoogle Scholar
  18. 18.
    Wilhelmsen L., Eriksson H., Svärdsudd K., Caidahl K.: Improving the detection and diagnosis of congestive heart failure. Eur. Heart J. 10 (Suppl. C): 13–18, 1989.PubMedCrossRefGoogle Scholar
  19. 19.
    Van den Broek S.A.J., van Veldhuisen D.J., de Graeff P.A., Landsman M.L., Hillege H., Lie K.I.: Comparison between New York Heart Association classification and peak oxygen consumption in the assessment of functional status and prognosis in patients with mild to moderate chronic congestive heart failure secondary to either ischemic or idiopathic dilated cardiomyopathy. Am. J. Cardiol. 70: 359–363, 1992.PubMedCrossRefGoogle Scholar
  20. 20.
    Gorkin L., Norvell N.K., Rosen R.C., Charles E., Shumaker S.A., McIntyre K.M., Capone R.J., Kostis J., Niaura R., Woods P., for the SOLVD Investigators: Assessment of quality of life as observed from the baseline data of the studies of left ventricular dysfunction (SOLVD) trial: quality-of-life substudy. Am. J. Cardiol. 71: 1069–1073, 1993.PubMedCrossRefGoogle Scholar
  21. 21.
    Likoff M.J., Chandler S.L., Kay H.R.: Clinical determinants of mortality in chronic congestive heart failure secondary to idiopathic, dilated or ischemic cardiomyopathy. Am. J. Cardiol. 59: 634–638, 1987.PubMedCrossRefGoogle Scholar
  22. 22.
    Gadsboll N., Hoilund-Carlsen P.F., Nielsen G.G., Berning J., Brunn N.E., Stage P., Hein E., Marving J., Longborg-Jensen H., Jensen B.H.: Symptoms and signs of heart failure in patients with myocardial infarction: Reproducibility and relationship to chest X-ray, radionuclide ventriculography and right heart catheterization. Eur. Heart J. 10: 1017–1028, 1989.PubMedGoogle Scholar
  23. 23.
    Hlatky M.A., Boineau R.E., Higginbotham M.B.: A brief self-administered questionnaire to determine functional capacity (the Duke Activity Status Index). Am. J. Cardiol. 64: 651–654, 1989.PubMedCrossRefGoogle Scholar
  24. 24.
    Butman S.M., Ewy G.A., Standen J.R., Kern K.B., Hahn E.: Bedside cardiovascular examination in patients with severe chronic heart failure: importance of rest or inducible jugular venous distension. J. Am. Coll. Cardiol. 22: 968–974, 1993.PubMedCrossRefGoogle Scholar
  25. 25.
    Judge K.W., Pawitan Y., Caldwell J., Gersh B.J., Kennedy J.W.: Congestive heart failure symptoms in patients with preserved left ventricular systolic function: analysis of the CASS registry. J. Am. Coll. Cardiol. 18: 377–382, 1991.PubMedCrossRefGoogle Scholar
  26. 26.
    Sahn D.J., DeMaria A., Kisslo J., Weyman A.: Recommendations regarding quantification in M-mode echocardiography: Results of a survey of echocardiographic measurements. Circulation 58: 1072–1081, 1978.PubMedCrossRefGoogle Scholar
  27. 27.
    Feinstein A.R.: Clinical biostatistic. XLI. Hard science, soft data, and challenges of choosing clinical variables in research. Clin. Pharmacol. Ther. 22: 485–498, 1977.PubMedGoogle Scholar
  28. 28.
    Klainer L.M., Gibson T.C., White K.L.: The epidemiology of cardiac failure. J. Chronic Dis. 18: 797–814, 1965.PubMedCrossRefGoogle Scholar
  29. 29.
    McFate Smith W.: Epidemiology of congestive heart failure. Am. J. Cardiol. 55: 3A–8A, 1985.CrossRefGoogle Scholar
  30. 30.
    Ho K.K.L., Pinsky J.L., Kannel W.B., Levy D.: The epidemiology of heart failure: The Framingham Study. J. Am. Coll. Cardiol. 22 (Suppl. A): 6A–13A, 1993.PubMedCrossRefGoogle Scholar
  31. 31.
    Selzer A., Cohn K.: Functional classification of cardiac disease: a critique. Am. J. Cardiol. 30: 306–308, 1972.PubMedCrossRefGoogle Scholar
  32. 32.
    Wagner S., Cohn K.: Heart failure: a proposed definition and classification. Arch. Intern. Med. 137: 675–678, 1977.PubMedCrossRefGoogle Scholar
  33. 33.
    Franciosa J.A., Park M., Levine T.N.: Lack of correlation between exercise capacity and indexes of resting left ventricular performance in heart failure. Am. J. Cardiol. 47: 33–39, 1982.CrossRefGoogle Scholar

Copyright information

© Springer Internal Publishing Switzerland 1998

Authors and Affiliations

  • D. Acanfora
    • 1
  • L. Trojano
    • 1
  • S. Maggi
    • 2
  • G. Furgi
    • 1
  • C. Rengo
    • 3
  • G. L. Iannuzzi
    • 1
  • A. Papa
    • 1
  • F. Rengo
    • 1
    • 3
  1. 1.IRCCS Rehabilitation Institute of Campoli M.T., Centro Medico di Telese Terme“Salvatore Maugeri” FoundationTelese Terme, BeneventoItaly
  2. 2.Targeted Project on AgingCNR (National Research Council)FirenzeItaly
  3. 3.Institute of Internal Medicine, Cardiology and Cardiovascular Surgery“Federico II” University, School of MedicineNapoliItaly

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