Heart failure is a clinical syndrome characterized by signs and symptoms of fluid overload represented as tissue edema and decreased perfusion.8 Different societies use a combination of history, physical examination findings, laboratory values, and noninvasive testing to define heart failure. (See Table 1.) The best validated criteria for the diagnosis of heart failure comes from the Framingham Study, which requires 2 major criteria or 1 major criterion and 2 minor criteria for the diagnosis of heart failure.8,9 (See Table 2.) Minor criteria are acceptable only if they cannot be attributed to another medical condition such as pulmonary hypertension, chronic lung disease, cirrhosis, ascites, or nephrotic syndrome.10 The Framingham criteria are 100% sensitive and 78% specific for identifying persons with definite heart failure.
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