Clinical Diagnosis of Congestive Heart Failure in Patients with Acute Dyspnea: Results (Part 1)

One hundred and three patients were considered for entry in this study. Of these, 52 were excluded (21 non-English speaking, two felt to be too unstable clinically, six disoriented, four left the emergency room before a physical examination could be performed, and 19 refused to participate), leaving 51 subjects. Those excluded were similar to those included with regard to age (mean age 68 in those excluded vs 64 in the study population), emergency room diagnosis of congestive heart failure (eight vs 12 patients), and admission rates (22 vs 26 admitted).
Of the remaining 51 patients in our study group, 31 were women (61 percent), and 20 (39 percent) were over age 65. Twelve patients (24 percent) were given a primary diagnosis of congestive heart failure by the emergency room physician. Our criteria for congestive heart failure were met in 23 patients (45 percent) (Table 2), with kappa = 0.30, indicating a degree of agreement generally considered fair . A paired chi-square statistic (McNemars test) gave a p value of 0.015, indicating that the emergency room physician diagnosed significantly fewer patients with congestive heart failure than would have been the case if our preestablished criteria had been applied. buy levaquin online

Table 2—Diagnosis of CHF by Criteria and by ER Physician

CHF

Total

Diagnosis by Criteria

Total

No CHF

CHF

9

3

12

ER diagnosis

No CHF

14

25

39

Total

23

28

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