Congestive heart failure clinical assessment

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Resident
Survival
Guide
Congestive Heart Failure Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Systolic Dysfunction
Diastolic Dysfunction
HFpEF
HFrEF

Causes

Differentiating Congestive heart failure from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Clinical Assessment

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

Chest X Ray

Cardiac MRI

Echocardiography

Exercise Stress Test

Myocardial Viability Studies

Cardiac Catheterization

Other Imaging Studies

Other Diagnostic Studies

Treatment

Invasive Hemodynamic Monitoring

Medical Therapy:

Summary
Acute Pharmacotherapy
Chronic Pharmacotherapy in HFpEF
Chronic Pharmacotherapy in HFrEF
Diuretics
ACE Inhibitors
Angiotensin receptor blockers
Aldosterone Antagonists
Beta Blockers
Ca Channel Blockers
Nitrates
Hydralazine
Positive Inotropics
Anticoagulants
Angiotensin Receptor-Neprilysin Inhibitor
Antiarrhythmic Drugs
Nutritional Supplements
Hormonal Therapies
Drugs to Avoid
Drug Interactions
Treatment of underlying causes
Associated conditions

Exercise Training

Surgical Therapy:

Biventricular Pacing or Cardiac Resynchronization Therapy (CRT)
Implantation of Intracardiac Defibrillator
Ultrafiltration
Cardiac Surgery
Left Ventricular Assist Devices (LVADs)
Cardiac Transplantation

ACC/AHA Guideline Recommendations

Initial and Serial Evaluation of the HF Patient
Hospitalized Patient
Patients With a Prior MI
Sudden Cardiac Death Prevention
Surgical/Percutaneous/Transcather Interventional Treatments of HF
Patients at high risk for developing heart failure (Stage A)
Patients with cardiac structural abnormalities or remodeling who have not developed heart failure symptoms (Stage B)
Patients with current or prior symptoms of heart failure (Stage C)
Patients with refractory end-stage heart failure (Stage D)
Coordinating Care for Patients With Chronic HF
Quality Metrics/Performance Measures

Implementation of Practice Guidelines

Congestive heart failure end-of-life considerations

Specific Groups:

Special Populations
Patients who have concomitant disorders
Obstructive Sleep Apnea in the Patient with CHF
NSTEMI with Heart Failure and Cardiogenic Shock

Congestive heart failure clinical assessment On the Web

Most recent articles

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CME Programs

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Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

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FDA on Congestive heart failure clinical assessment

CDC on Congestive heart failure clinical assessment

Congestive heart failure clinical assessment in the news

Blogs on Congestive heart failure clinical assessment

Directions to Hospitals Treating Congestive heart failure clinical assessment

Risk calculators and risk factors for Congestive heart failure clinical assessment

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Edzel Lorraine Co, D.M.D., M.D. [2]

Overview

Clinical assessment of a patient based on a thorough history taking and physical examination is still the cornerstone in diagnosing heart failure. Based on the gathered data, patients can be assessed if he has an underlying heart condition which necessitates a disease-specific therapy such as amyloid heart disease, a cardiomyopathy, or a developing decompensated heart failure. It is important to investigate for presence of heart congestion so as to treat it the at the earliest stage to avoid deterioration in the quality of life and prognosis.

Diagnostic algorithm for heart failure

 
 
 
 
 
 
 
 
Suspected heart failure
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
NT-proBNP ≥ 125 pg/mL or BNP ≥ 35 pg/mL

or if HF strongly suspected

or if NT-proBNP/BNP unavailable
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Echocardiography
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Abnormal findings
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Hear failure unlikely, other dignosis shoulb be considered
 
NO
 
Yes
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Heart failure confirmed based on LVEF
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
LVEF≤ 40%
 
 
 
 
LVEF=41-49%
 
 
 
 
LVEF≥50%
The above table adopted from 2021 ESC Guideline

[1]


Criteria for definition of advanced heart failure

1. Severe and persistent symptoms of heart failure NYHA class III-IV
2. Severe cardiac dysfunction is defined by at least one of the following:

3. Episodes of pulmonary or systemic congestion requiring high-dose i.v. diuretics (or diuretic combinations) or episodes of low output requiring inotropes or vasoactive drugs or malignant arrhythmias causing >1 unplanned visit or hospitalization in the last 12 months
4. Severe impairment of exercise capacity with inability to exercise or low 6MWT distance (<300 m) or pVO2 <12 mL/kg/min or <50% predicted value, estimated to be of cardiac origin[1]

Clinical Assessment

Framingham Criteria

Major Criteria

Minor Criteria

Boston Criteria of Congestive Heart Failure

Category I: History

Category II: Physical Examination

Category III: Chest Radiography

No more than 4 points are allowed from each of three categories; hence the composite score (the sum of the subtotal from each category) has a possible maximum of 12 points.

The diagnosis of heart failure is classified as "definite" at a score of 8 to 12 points, "possible" at a score of 5 to 7 points, and "unlikely" at a score of 4 points or less.

2022 AHA/ACC/HFSA Heart Failure Guideline (DO NOT EDIT) [2]

Initial and Serial Evaluation 2022 AHA/ACC/HFSA Heart Failure Guideline (DO NOT EDIT) [2]

Clinical Assessment: History and Physical Examination 2022 AHA/ACC/HFSA Heart Failure Guideline (DO NOT EDIT) [2]

Class I
"1. In patients with HF, vital signs and evidence of clinical congestion should be assessed at each encounter to guide overall management, including adjustment of diuretics and other medications.[3][4][5][6][7][8] (Level of Evidence: B-NR) "
"2. In patients with symptomatic HF, clinical factors indicating the presence of advanced HF should be sought via the history and physical examination. [9][10][11][12][13][14] (Level of Evidence: B-NR) "
"3. In patients with cardiomyopathy, a 3-generation family history should be obtained or updated when assessing the cause of the cardiomyopathy to identify possible inherited disease. [15][16] (Level of Evidence: B-NR) "
"4. In patients presenting with HF, a thorough history and physical examination should direct diagnostic strategies to uncover specific causes that may warrant disease-specific management. [17][18] (Level of Evidence: B-NR) "
"4. In patients presenting with HF, a thorough history and physical examination should be obtained and performed to identify cardiac and noncardiac disorders, lifestyle and behavioral factors, and social determinants of health that might cause or accelerate the development or progression of HF. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C-EO]) "

Initial Laboratory and Electrocardiographic Testing 2022 AHA/ACC/HFSA Heart Failure Guideline (DO NOT EDIT) [2]

Class I
"1. For patients presenting with HF, the specific cause of HF should be explored using additional laboratory testing for appropriate management. [19][20][21][22][23][24][25][26] (Level of Evidence: B-NR) "
"2. For patients who are diagnosed with HF, laboratory evaluation should include complete blood count, urinalysis, serum electrolytes, blood urea nitrogen, serum creatinine, glucose, lipid profile, liver function tests, iron studies, and thyroid-stimulating hormone to optimize management. (Level of Evidence: C-EO) "
"3. For all patients presenting with HF, a 12-lead ECG should be performed at the initial ecounter to optimize management. (Level of Evidence: C-EO) "

Use of Biomarkers for Prevention, Initial Diagnosis, and Risk Stratification (DO NOT EDIT) [2]

Class I
"1. In patients presenting with dyspnea, measurement of B-type natriuretic peptide (BNP) or N-terminal prohormone of B-type natriuretic peptide (NT-proBNP) is useful to support a diagnosis or exclusion of HF. [27][28][29][30][31][32][33][34][35][36][37][38] (Level of Evidence: A) "
"2.In patients with chronic HF, measurements of BNP or NT-proBNP levels are recommended for risk stratification. [37][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55] (Level of Evidence: A) "
"3. In patients hospitalized for HF, measurement of BNP or NT-proBNP levels at admission is recommended to establish prognosis. [37][39][40][41][42][43][44][45] (Level of Evidence: A) "
Class IIa
"4. In patients at risk of developing HF, BNP or NT-proBNP-based screening followed by team-based care, including a cardiovascular specialist, can be useful to prevent the development of LV dysfunction or new-onset HF. [56][57] (Level of Evidence: B-R) "
"5.In patients hospitalized for HF, a predischarge BNP or NT-proBNP level can be useful to inform the trajectory of the patient and establish a postdischarge prognosis. [40][43][46][47][48][49][50][51][52][53][54][55] (Level of Evidence: B-NR) "

Genetic Evaluation and Testing 2022 AHA/ACC/HFSA Heart Failure Guideline (DO NOT EDIT) [2]

Class I
"1. In first degree (Level of Evidence: B-R) "


Evaluation With Cardiac Imaging 2022 AHA/ACC/HFSA Heart Failure Guideline (DO NOT EDIT) [2]

Invasive Evaluation 2022 AHA/ACC/HFSA Heart Failure Guideline (DO NOT EDIT) [2]

Wearables and Remote Monitoring (Including Telemonitoring and Device Monitoring) 2022 AHA/ACC/HFSA Heart Failure Guideline (DO NOT EDIT) [2]

Exercise and Functional Capacity Testing 2022 AHA/ACC/HFSA Heart Failure Guideline (DO NOT EDIT) [2]

Initial and Serial Evaluation: Clinical Assessment: HF Risk Scoring 2022 AHA/ACC/HFSA Heart Failure Guideline (DO NOT EDIT) [2]

Source

References

  1. ↑ 1.0 1.1 McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, Čelutkienė J, Chioncel O, Cleland J, Coats A, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam C, Lyon AR, McMurray J, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano G, Ruschitzka F, Kathrine Skibelund A (September 2021). "2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure". Eur Heart J. 42 (36): 3599–3726. doi:10.1093/eurheartj/ehab368. PMID 34447992 Check |pmid= value (help). Vancouver style error: initials (help)
  2. ↑ 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM; et al. (2022). "2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines". Circulation. 145 (18): e876–e894. doi:10.1161/CIR.0000000000001062. PMID 35363500 Check |pmid= value (help).
  3. ↑ Ambrosy AP, Pang PS, Khan S, Konstam MA, Fonarow GC, Traver B; et al. (2013). "Clinical course and predictive value of congestion during hospitalization in patients admitted for worsening signs and symptoms of heart failure with reduced ejection fraction: findings from the EVEREST trial". Eur Heart J. 34 (11): 835–43. doi:10.1093/eurheartj/ehs444. PMID 23293303.
  4. ↑ Selvaraj S, Claggett B, Pozzi A, McMurray JJV, Jhund PS, Packer M; et al. (2019). "Prognostic Implications of Congestion on Physical Examination Among Contemporary Patients With Heart Failure and Reduced Ejection Fraction: PARADIGM-HF". Circulation. 140 (17): 1369–1379. doi:10.1161/CIRCULATIONAHA.119.039920. PMID 31510768.
  5. ↑ Selvaraj S, Claggett B, Shah SJ, Anand IS, Rouleau JL, Desai AS; et al. (2019). "Utility of the Cardiovascular Physical Examination and Impact of Spironolactone in Heart Failure With Preserved Ejection Fraction". Circ Heart Fail. 12 (7): e006125. doi:10.1161/CIRCHEARTFAILURE.119.006125. PMC 6686863 Check |pmc= value (help). PMID 31220936.
  6. ↑ Caldentey G, Khairy P, Roy D, Leduc H, Talajic M, Racine N; et al. (2014). "Prognostic value of the physical examination in patients with heart failure and atrial fibrillation: insights from the AF-CHF trial (atrial fibrillation and chronic heart failure)". JACC Heart Fail. 2 (1): 15–23. doi:10.1016/j.jchf.2013.10.004. PMID 24622114.
  7. ↑ Simonavičius J, Sanders van-Wijk S, Rickenbacher P, Maeder MT, Pfister O, Kaufmann BA; et al. (2019). "Prognostic Significance of Longitudinal Clinical Congestion Pattern in Chronic Heart Failure: Insights From TIME-CHF Trial". Am J Med. 132 (9): e679–e692. doi:10.1016/j.amjmed.2019.04.010. PMID 31051151.
  8. ↑ Fudim M, Parikh KS, Dunning A, DeVore AD, Mentz RJ, Schulte PJ; et al. (2018). "Relation of Volume Overload to Clinical Outcomes in Acute Heart Failure (From ASCEND-HF)". Am J Cardiol. 122 (9): 1506–1512. doi:10.1016/j.amjcard.2018.07.023. PMC 6924269 Check |pmc= value (help). PMID 30172362.
  9. ↑ Anker SD, Negassa A, Coats AJ, Afzal R, Poole-Wilson PA, Cohn JN; et al. (2003). "Prognostic importance of weight loss in chronic heart failure and the effect of treatment with angiotensin-converting-enzyme inhibitors: an observational study". Lancet. 361 (9363): 1077–83. doi:10.1016/S0140-6736(03)12892-9. PMID 12672310.
  10. ↑ Eshaghian S, Horwich TB, Fonarow GC (2006). "Relation of loop diuretic dose to mortality in advanced heart failure". Am J Cardiol. 97 (12): 1759–64. doi:10.1016/j.amjcard.2005.12.072. PMID 16765130.
  11. ↑ Gorodeski EZ, Chu EC, Reese JR, Shishehbor MH, Hsich E, Starling RC (2009). "Prognosis on chronic dobutamine or milrinone infusions for stage D heart failure". Circ Heart Fail. 2 (4): 320–4. doi:10.1161/CIRCHEARTFAILURE.108.839076. PMID 19808355.
  12. ↑ Kittleson M, Hurwitz S, Shah MR, Nohria A, Lewis E, Givertz M; et al. (2003). "Development of circulatory-renal limitations to angiotensin-converting enzyme inhibitors identifies patients with severe heart failure and early mortality". J Am Coll Cardiol. 41 (11): 2029–35. doi:10.1016/s0735-1097(03)00417-0. PMID 12798577.
  13. ↑ Poole JE, Johnson GW, Hellkamp AS, Anderson J, Callans DJ, Raitt MH; et al. (2008). "Prognostic importance of defibrillator shocks in patients with heart failure". N Engl J Med. 359 (10): 1009–17. doi:10.1056/NEJMoa071098. PMC 2922510. PMID 18768944.
  14. ↑ Setoguchi S, Stevenson LW, Schneeweiss S (2007). "Repeated hospitalizations predict mortality in the community population with heart failure". Am Heart J. 154 (2): 260–6. doi:10.1016/j.ahj.2007.01.041. PMID 17643574.
  15. ↑ Marume K, Noguchi T, Tateishi E, Morita Y, Miura H, Nishimura K; et al. (2020). "Prognosis and Clinical Characteristics of Dilated Cardiomyopathy With Family History via Pedigree Analysis". Circ J. 84 (8): 1284–1293. doi:10.1253/circj.CJ-19-1176. PMID 32624524 Check |pmid= value (help).
  16. ↑ Waddell-Smith KE, Donoghue T, Oates S, Graham A, Crawford J, Stiles MK; et al. (2016). "Inpatient detection of cardiac-inherited disease: the impact of improving family history taking". Open Heart. 3 (1): e000329. doi:10.1136/openhrt-2015-000329. PMC 4762189. PMID 26925241.
  17. ↑ González-López E, Gagliardi C, Dominguez F, Quarta CC, de Haro-Del Moral FJ, Milandri A; et al. (2017). "Clinical characteristics of wild-type transthyretin cardiac amyloidosis: disproving myths". Eur Heart J. 38 (24): 1895–1904. doi:10.1093/eurheartj/ehx043. PMID 28329248.
  18. ↑ Lousada I, Comenzo RL, Landau H, Guthrie S, Merlini G (2015). "Light Chain Amyloidosis: Patient Experience Survey from the Amyloidosis Research Consortium". Adv Ther. 32 (10): 920–8. doi:10.1007/s12325-015-0250-0. PMC 4635176. PMID 26498944.
  19. ↑ Cardinale D, Colombo A, Bacchiani G, Tedeschi I, Meroni CA, Veglia F; et al. (2015). "Early detection of anthracycline cardiotoxicity and improvement with heart failure therapy". Circulation. 131 (22): 1981–8. doi:10.1161/CIRCULATIONAHA.114.013777. PMID 25948538 : 25948538 Check |pmid= value (help).
  20. ↑ Cardinale D, Sandri MT, Colombo A, Colombo N, Boeri M, Lamantia G; et al. (2004). "Prognostic value of troponin I in cardiac risk stratification of cancer patients undergoing high-dose chemotherapy". Circulation. 109 (22): 2749–54. doi:10.1161/01.CIR.0000130926.51766.CC. PMID 15148277.
  21. ↑ Castaño A, Narotsky DL, Hamid N, Khalique OK, Morgenstern R, DeLuca A; et al. (2017). "Unveiling transthyretin cardiac amyloidosis and its predictors among elderly patients with severe aortic stenosis undergoing transcatheter aortic valve replacement". Eur Heart J. 38 (38): 2879–2887. doi:10.1093/eurheartj/ehx350. PMC 5837725. PMID 29019612.
  22. ↑ Maurer MS, Hanna M, Grogan M, Dispenzieri A, Witteles R, Drachman B; et al. (2016). "Genotype and Phenotype of Transthyretin Cardiac Amyloidosis: THAOS (Transthyretin Amyloid Outcome Survey)". J Am Coll Cardiol. 68 (2): 161–72. doi:10.1016/j.jacc.2016.03.596. PMC 4940135. PMID 27386769.
  23. ↑ Gillmore JD, Maurer MS, Falk RH, Merlini G, Damy T, Dispenzieri A; et al. (2016). "Nonbiopsy Diagnosis of Cardiac Transthyretin Amyloidosis". Circulation. 133 (24): 2404–12. doi:10.1161/CIRCULATIONAHA.116.021612. PMID 27143678.
  24. ↑ Brown EE, Lee YZJ, Halushka MK, Steenbergen C, Johnson NM, Almansa J; et al. (2017). "Genetic testing improves identification of transthyretin amyloid (ATTR) subtype in cardiac amyloidosis". Amyloid. 24 (2): 92–95. doi:10.1080/13506129.2017.1324418. PMID 28494620.
  25. ↑ Crawford TC, Okada DR, Magruder JT, Fraser C, Patel N, Houston BA; et al. (2018). "A Contemporary Analysis of Heart Transplantation and Bridge-to-Transplant Mechanical Circulatory Support Outcomes in Cardiac Sarcoidosis". J Card Fail. 24 (6): 384–391. doi:10.1016/j.cardfail.2018.02.009. PMID 29482029.
  26. ↑ Wu RS, Gupta S, Brown RN, Yancy CW, Wald JW, Kaiser P; et al. (2010). "Clinical outcomes after cardiac transplantation in muscular dystrophy patients". J Heart Lung Transplant. 29 (4): 432–8. doi:10.1016/j.healun.2009.08.030. PMID 19864165.
  27. ↑ Richards AM, Doughty R, Nicholls MG, MacMahon S, Sharpe N, Murphy J; et al. (2001). "Plasma N-terminal pro-brain natriuretic peptide and adrenomedullin: prognostic utility and prediction of benefit from carvedilol in chronic ischemic left ventricular dysfunction. Australia-New Zealand Heart Failure Group". J Am Coll Cardiol. 37 (7): 1781–7. doi:10.1016/s0735-1097(01)01269-4. PMID 11401111.
  28. ↑ Tang WH, Girod JP, Lee MJ, Starling RC, Young JB, Van Lente F; et al. (2003). "Plasma B-type natriuretic peptide levels in ambulatory patients with established chronic symptomatic systolic heart failure". Circulation. 108 (24): 2964–6. doi:10.1161/01.CIR.0000106903.98196.B6. PMID 14662703.
  29. ↑ Zaphiriou A, Robb S, Murray-Thomas T, Mendez G, Fox K, McDonagh T; et al. (2005). "The diagnostic accuracy of plasma BNP and NTproBNP in patients referred from primary care with suspected heart failure: results of the UK natriuretic peptide study". Eur J Heart Fail. 7 (4): 537–41. doi:10.1016/j.ejheart.2005.01.022. PMID 15921792.
  30. ↑ Son CS, Kim YN, Kim HS, Park HS, Kim MS (2012). "Decision-making model for early diagnosis of congestive heart failure using rough set and decision tree approaches". J Biomed Inform. 45 (5): 999–1008. doi:10.1016/j.jbi.2012.04.013. PMID 22564550.
  31. ↑ Kelder JC, Cramer MJ, van Wijngaarden J, van Tooren R, Mosterd A, Moons KG; et al. (2011). "The diagnostic value of physical examination and additional testing in primary care patients with suspected heart failure". Circulation. 124 (25): 2865–73. doi:10.1161/CIRCULATIONAHA.111.019216. PMID 22104551.
  32. ↑ Booth RA, Hill SA, Don-Wauchope A, Santaguida PL, Oremus M, McKelvie R; et al. (2014). "Performance of BNP and NT-proBNP for diagnosis of heart failure in primary care patients: a systematic review". Heart Fail Rev. 19 (4): 439–51. doi:10.1007/s10741-014-9445-8. PMID 24969534.
  33. ↑ Dao Q, Krishnaswamy P, Kazanegra R, Harrison A, Amirnovin R, Lenert L; et al. (2001). "Utility of B-type natriuretic peptide in the diagnosis of congestive heart failure in an urgent-care setting". J Am Coll Cardiol. 37 (2): 379–85. doi:10.1016/s0735-1097(00)01156-6. PMID 11216950.
  34. ↑ Davis M, Espiner E, Richards G, Billings J, Town I, Neill A; et al. (1994). "Plasma brain natriuretic peptide in assessment of acute dyspnoea". Lancet. 343 (8895): 440–4. doi:10.1016/s0140-6736(94)92690-5. PMID 7905953.
  35. ↑ Maisel AS, Krishnaswamy P, Nowak RM, McCord J, Hollander JE, Duc P; et al. (2002). "Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure". N Engl J Med. 347 (3): 161–7. doi:10.1056/NEJMoa020233. PMID 12124404. Review in: J Fam Pract. 2002 Oct;51(10):816 Review in: ACP J Club. 2003 Jan-Feb;138(1):23
  36. ↑ Januzzi JL, Chen-Tournoux AA, Moe G (2008). "Amino-terminal pro-B-type natriuretic peptide testing for the diagnosis or exclusion of heart failure in patients with acute symptoms". Am J Cardiol. 101 (3A): 29–38. doi:10.1016/j.amjcard.2007.11.017. PMID 18243855.
  37. ↑ 37.0 37.1 37.2 Santaguida PL, Don-Wauchope AC, Ali U, Oremus M, Brown JA, Bustamam A; et al. (2014). "Incremental value of natriuretic peptide measurement in acute decompensated heart failure (ADHF): a systematic review". Heart Fail Rev. 19 (4): 507–19. doi:10.1007/s10741-014-9444-9. PMID 25052418.
  38. ↑ Hill SA, Booth RA, Santaguida PL, Don-Wauchope A, Brown JA, Oremus M; et al. (2014). "Use of BNP and NT-proBNP for the diagnosis of heart failure in the emergency department: a systematic review of the evidence". Heart Fail Rev. 19 (4): 421–38. doi:10.1007/s10741-014-9447-6. PMID 24957908.
  39. ↑ 39.0 39.1 van Kimmenade RR, Januzzi JL, Ellinor PT, Sharma UC, Bakker JA, Low AF; et al. (2006). "Utility of amino-terminal pro-brain natriuretic peptide, galectin-3, and apelin for the evaluation of patients with acute heart failure". J Am Coll Cardiol. 48 (6): 1217–24. doi:10.1016/j.jacc.2006.03.061. PMID 16979009.
  40. ↑ 40.0 40.1 40.2 Bettencourt P, Azevedo A, Pimenta J, Friões F, Ferreira S, Ferreira A (2004). "N-terminal-pro-brain natriuretic peptide predicts outcome after hospital discharge in heart failure patients". Circulation. 110 (15): 2168–74. doi:10.1161/01.CIR.0000144310.04433.BE. PMID 15451800.
  41. ↑ 41.0 41.1 Cheng V, Kazanagra R, Garcia A, Lenert L, Krishnaswamy P, Gardetto N; et al. (2001). "A rapid bedside test for B-type peptide predicts treatment outcomes in patients admitted for decompensated heart failure: a pilot study". J Am Coll Cardiol. 37 (2): 386–91. doi:10.1016/s0735-1097(00)01157-8. PMID 11216951.
  42. ↑ 42.0 42.1 Fonarow GC, Peacock WF, Phillips CO, Givertz MM, Lopatin M, ADHERE Scientific Advisory Committee and Investigators (2007). "Admission B-type natriuretic peptide levels and in-hospital mortality in acute decompensated heart failure". J Am Coll Cardiol. 49 (19): 1943–50. doi:10.1016/j.jacc.2007.02.037. PMID 17498579.
  43. ↑ 43.0 43.1 43.2 Logeart D, Thabut G, Jourdain P, Chavelas C, Beyne P, Beauvais F; et al. (2004). "Predischarge B-type natriuretic peptide assay for identifying patients at high risk of re-admission after decompensated heart failure". J Am Coll Cardiol. 43 (4): 635–41. doi:10.1016/j.jacc.2003.09.044. PMID 14975475.
  44. ↑ 44.0 44.1 Maisel A, Hollander JE, Guss D, McCullough P, Nowak R, Green G; et al. (2004). "Primary results of the Rapid Emergency Department Heart Failure Outpatient Trial (REDHOT). A multicenter study of B-type natriuretic peptide levels, emergency department decision making, and outcomes in patients presenting with shortness of breath". J Am Coll Cardiol. 44 (6): 1328–33. doi:10.1016/j.jacc.2004.06.015. PMID 15364340.
  45. ↑ 45.0 45.1 Zairis MN, Tsiaousis GZ, Georgilas AT, Makrygiannis SS, Adamopoulou EN, Handanis SM; et al. (2010). "Multimarker strategy for the prediction of 31 days cardiac death in patients with acutely decompensated chronic heart failure". Int J Cardiol. 141 (3): 284–90. doi:10.1016/j.ijcard.2008.12.017. PMID 19157603.
  46. ↑ 46.0 46.1 Dhaliwal AS, Deswal A, Pritchett A, Aguilar D, Kar B, Souchek J; et al. (2009). "Reduction in BNP levels with treatment of decompensated heart failure and future clinical events". J Card Fail. 15 (4): 293–9. doi:10.1016/j.cardfail.2008.11.007. PMID 19398076.
  47. ↑ 47.0 47.1 O'Connor CM, Hasselblad V, Mehta RH, Tasissa G, Califf RM, Fiuzat M; et al. (2010). "Triage after hospitalization with advanced heart failure: the ESCAPE (Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness) risk model and discharge score". J Am Coll Cardiol. 55 (9): 872–8. doi:10.1016/j.jacc.2009.08.083. PMC 3835158. PMID 20185037.
  48. ↑ 48.0 48.1 O'Brien RJ, Squire IB, Demme B, Davies JE, Ng LL (2003). "Pre-discharge, but not admission, levels of NT-proBNP predict adverse prognosis following acute LVF". Eur J Heart Fail. 5 (4): 499–506. doi:10.1016/s1388-9842(03)00098-9. PMID 12921811.
  49. ↑ 49.0 49.1 Cohen-Solal A, Logeart D, Huang B, Cai D, Nieminen MS, Mebazaa A (2009). "Lowered B-type natriuretic peptide in response to levosimendan or dobutamine treatment is associated with improved survival in patients with severe acutely decompensated heart failure". J Am Coll Cardiol. 53 (25): 2343–8. doi:10.1016/j.jacc.2009.02.058. PMID 19539144.
  50. ↑ 50.0 50.1 Salah K, Kok WE, Eurlings LW, Bettencourt P, Pimenta JM, Metra M; et al. (2014). "A novel discharge risk model for patients hospitalised for acute decompensated heart failure incorporating N-terminal pro-B-type natriuretic peptide levels: a European coLlaboration on Acute decompeNsated Heart Failure: ELAN-HF Score". Heart. 100 (2): 115–25. doi:10.1136/heartjnl-2013-303632. PMID 24179162.
  51. ↑ 51.0 51.1 Flint KM, Allen LA, Pham M, Heidenreich PA (2014). "B-type natriuretic peptide predicts 30-day readmission for heart failure but not readmission for other causes". J Am Heart Assoc. 3 (3): e000806. doi:10.1161/JAHA.114.000806. PMC 4309072. PMID 24922626.
  52. ↑ 52.0 52.1 Kociol RD, Horton JR, Fonarow GC, Reyes EM, Shaw LK, O'Connor CM; et al. (2011). "Admission, discharge, or change in B-type natriuretic peptide and long-term outcomes: data from Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF) linked to Medicare claims". Circ Heart Fail. 4 (5): 628–36. doi:10.1161/CIRCHEARTFAILURE.111.962290. PMC 3465672. PMID 21743005.
  53. ↑ 53.0 53.1 Kociol RD, McNulty SE, Hernandez AF, Lee KL, Redfield MM, Tracy RP; et al. (2013). "Markers of decongestion, dyspnea relief, and clinical outcomes among patients hospitalized with acute heart failure". Circ Heart Fail. 6 (2): 240–5. doi:10.1161/CIRCHEARTFAILURE.112.969246. PMC 3865520. PMID 23250981.
  54. ↑ 54.0 54.1 Verdiani V, Ognibene A, Rutili MS, Lombardo C, Bacci F, Terreni A; et al. (2008). "NT-ProBNP reduction percentage during hospital stay predicts long-term mortality and readmission in heart failure patients". J Cardiovasc Med (Hagerstown). 9 (7): 694–9. doi:10.2459/JCM.0b013e3282f447ae. PMID 18545069.
  55. ↑ 55.0 55.1 Bayés-Genís A, Lopez L, Zapico E, Cotes C, Santaló M, Ordonez-Llanos J; et al. (2005). "NT-ProBNP reduction percentage during admission for acutely decompensated heart failure predicts long-term cardiovascular mortality". J Card Fail. 11 (5 Suppl): S3–8. doi:10.1016/j.cardfail.2005.04.006. PMID 15948093.
  56. ↑ Huelsmann M, Neuhold S, Resl M, Strunk G, Brath H, Francesconi C; et al. (2013). "PONTIAC (NT-proBNP selected prevention of cardiac events in a population of diabetic patients without a history of cardiac disease): a prospective randomized controlled trial". J Am Coll Cardiol. 62 (15): 1365–72. doi:10.1016/j.jacc.2013.05.069. PMID 23810874.
  57. ↑ Ledwidge M, Gallagher J, Conlon C, Tallon E, O'Connell E, Dawkins I; et al. (2013). "Natriuretic peptide-based screening and collaborative care for heart failure: the STOP-HF randomized trial". JAMA. 310 (1): 66–74. doi:10.1001/jama.2013.7588. PMID 23821090. Review in: Evid Based Med. 2014 Jun;19(3):107
  58. ↑ Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Colvin MM, Deswal A, Drazner MH, Dunlay SM, Evers LR, Fang JC, Fedson SE, Fonarow GC, Hayek SS, Hernandez AF, Khazanie P, Kittleson MM, Lee CS, Link MS, Milano CA, Nnacheta LC, Sandhu AT, Stevenson LW, Vardeny O, Vest AR, Yancy CW (May 2022). "2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines". Circulation. 145 (18): e895–e1032. doi:10.1161/CIR.0000000000001063. PMID 35363499 Check |pmid= value (help).

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