Cody listed criteria for diagnosis of refractory congestive heart failure.

The author is from The Ohio State University in Columbus.

Criteria for refractory congestive heart failure:

(1) New York Heart Association (NYHA) functional class III or IV

(2) failure to respond to maximal drug therapy including all of the following:

(2a) diuretics

(2b) digoxin

(2c) ACE inhibitor or other vasodilator


Risk factors associated with refractory heart failure:

(1) acute myocardial ischemia or infarction

(2) new or progressive cardiac valve dysfunction (usually affecting the mitral or aortic valve)

(3) new or progressive myocardial disease

(4) inadequately controlled hypertension

(5) diabetes mellitus

(6) failure to adhere to restrictions on sodium intake

(7) progressive renal disease

(8) progression of co-existent pulmonary disease or occurrence of a pulmonary embolism

(9) progression in another serious comorbid condition

(10) patient noncompliance with or misunderstanding of the drug regimen



• The therapeutic options have expanded since the paper was written. Digoxin is less used today.

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