title: Does the physical examination still have a role in patients with suspected heart failure?
abstract: OBJECTIVE
  The prognostic value of signs of congestion in patients suspected of having chronic heart failure (CHF) is unknown. Our objectives were to define their prevalence and specificity in diagnosing CHF and to determine their prognostic value in patients in a community heart failure clinic.
  
  
  RESULTS
  Analysis of referrals to a community clinic for patients with CHF symptoms. Systolic CHF (S-HF) was defined as left ventricular ejection fraction (LVEF) ≤45%, heart failure with normal ejection fraction (HeFNEF) as LVEF > 45%, and amino-terminal pro-brain natriuretic peptide >50 pmol L(-1); other subjects were defined as not having CHF. Signs of congestion were as follows: no signs; right heart congestion (RHC: oedema, jugular venous distension); left heart congestion (LHC: lung crackles); or both (R + LHC). Of 1881 patients referred, 707 did not have CHF, 853 had S-HF, and 321 had HeFNEF. The median inter-quartile range (IQR) age was 72 years (64-78), 40% were women, and LVEF was 47% (35-59). Overall, 417 patients had RHC of whom 49% had S-HF and 21% HeFNEF. Eighty-five patients had LHC of whom 43% had S-HF and 20% had HeFNEF. One hundred and seventy-two patients had R + LHC of whom 71% had S-HF and 16% had HeFNEF. During a median (IQR) follow-up of 64(44-76) months, 40% of the entire patient cohort died. The combination of R + LHC signs was an independent marker of an adverse prognosis (χ(2)-log-rank test = 186.1, P< 0.0001).
  
  
  CONCLUSIONS
  Clinical signs of congestion are independent predictors of prognosis in ambulatory patients with suspected CHF.
authors: Department of Cardiology, University of Hull, Castle Hill Hospital, Kingston-upon-Hull, Cottingham, UK. thibaud.damy@hmn.aphp.fr
authors: Thibaud
authors: T
authors: Damy
authors: Anna
authors: A
authors: Kallvikbacka-Bennett
authors: Jufen
authors: J
authors: Zhang
authors: Kevin
authors: K
authors: Goode
authors: Laszlo
authors: L
authors: Buga
authors: James
authors: J
authors: Hobkirk
authors: Ashraf
authors: A
authors: Yassin
authors: Jean-Luc
authors: JL
authors: Dubois-Randé
authors: Luc
authors: L
authors: Hittinger
authors: John G F
authors: JG
authors: Cleland
authors: Andrew L
authors: AL
authors: Clark
mesh_terms: D000368:Aged; D003937:Diagnosis, Differential; D004487:Edema / Q000175:diagnosis / Q000209:etiology; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D006940:Hyperemia / Q000175:diagnosis* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010808:Physical Examination; D015995:Prevalence; D011379:Prognosis; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D006113:United Kingdom / Q000453:epidemiology