Prosen et al developed a modified set of criteria for congestive heart failure (CHF) based on the original Boston criteria. This allows for patient assessment prior to availability of chest radiography (the third category in the original criteria). The authors are from the Center for Emergency Medicine in Maribor, University of Maribor, and University of Ljubljana in Slovenia..
Finding categories:
(1) history
(2) physical examination
(3) additional minor criteria (replacing chest radiography)
|
Category I: History |
Findings |
Points |
|
rest dyspnea |
absent |
0 |
|
|
present |
4 |
|
orthopnea |
absent |
0 |
|
|
present |
4 |
|
paroxysmal nocturnal dyspnea |
absent |
0 |
|
|
present |
3 |
|
dyspnea on walking on level area |
absent |
0 |
|
|
present |
2 |
|
dyspnea on climbing |
absent |
0 |
|
|
present |
1 |
points for history =
= MIN(4,SUM(points for findings present))
|
Category II: Physical Exam |
Finding |
Points |
|
heart rate abnormality |
<= 90 beats/min |
0 |
|
|
91-110 beats/min |
1 |
|
|
> 110 beats/min |
2 |
|
jugular venous pressure elevation |
<= 5 cm H2O |
0 |
|
|
> 5 cm H2O |
2 |
|
|
> 5 cm H2O plus (hepatomegaly or edema) |
3 |
|
lung crackles |
none |
0 |
|
|
basilar |
1 |
|
|
more than basilar |
2 |
|
wheezing |
present |
3 |
|
|
absent |
0 |
|
third heart sound |
present |
3 |
|
|
absent |
0 |
where:
• The original Boston criteria use > 6 cm H2O for jugular venous pressure (see Boston Criteria for Diagnosis Congestive Heart Failure).
points for physical examination =
= MIN(4,SUM(points for findings present))
|
Category: Minor Criteria |
Finding |
Points |
|
hepatojugular reflex |
absent |
0 |
|
|
present |
1 |
|
ECG changes (left ventricular hypertrophy, old AMI, nonspecific ST-T changes, arrhythmia) |
absent |
0 |
|
|
present |
1 |
|
cought at night |
absent |
0 |
|
|
present |
1 |
|
cardiac murmur |
absent |
0 |
|
|
present |
1 |
|
sputum or fever |
absent |
1 |
|
|
present |
0 |
|
history of previous AMI, arrhythmia and/or CHF |
absent |
0 |
|
|
present |
1 |
|
heart failure medications |
absent |
0 |
|
|
present |
1 |
points for additional minor criteria =
= MIN(4,SUM(points for findings present))
score =
= (points for history) + (points for physical examination) + (points for additional minor criteria)
Interpretation:
• minimum score: 0
• maximum score: 12
• The higher the score the greater the likelihood of congestive heart failure.
|
Score |
Congestive Heart Failure |
|
<= 4 |
unlikely |
|
5 - 7 |
possible |
|
>= 8 |
definite |
Purpose: To diagnose congestive heart failure (CHF) in a prehospital setting using a modification of the Boston criteria as reported by Prosen et al.
Specialty: Cardiology
Objective: imaging studies, laboratory tests, criteria for diagnosis
ICD-10: I50,
