ToolsCalculators
Framingham Heart Failure Diagnostic Criteria
Bedside major/minor criteria for a clinical diagnosis of congestive heart failure.
Framingham Heart Failure Diagnostic Criteria
Paroxysmal nocturnal dyspnoea or orthopnoea
Neck-vein distension
Pulmonary rales
Radiographic cardiomegaly
Acute pulmonary oedema
S3 gallop
Venous pressure >16 cmH2O
Positive hepatojugular reflux
Bilateral ankle oedema
Nocturnal cough
Dyspnoea on ordinary exertion
Hepatomegaly
Pleural effusion
Vital capacity reduced by one-third of the recorded maximum
Heart rate >120 bpm
Weight loss >=4.5 kg over 5 days in response to treatment
Counts as either a major or a minor criterion, whichever completes the diagnosis.
ResultCriteria not met
Does not satisfy the Framingham definition of heart failure with the findings entered.
- Major criteria present
- 0
- Minor criteria present
- 0
- Weight-loss criterion
- Absent
When to use
- Supporting a bedside clinical diagnosis of congestive heart failure using history and examination alone.
- Historical epidemiological definition, still referenced when natriuretic peptide testing or echocardiography is not yet available.
Formula
Diagnosis requires >=2 major criteria, or 1 major criterion plus >=2 minor criteria, present at the same time. Minor criteria only count if not attributable to another condition. Weight loss >=4.5 kg in 5 days with treatment may be counted as either a major or a minor criterion.
Pearls and pitfalls
- Derived from the original Framingham Heart Study cohort, decades before natriuretic peptides or echocardiography were in routine use.
- High sensitivity but limited specificity compared with modern imaging- and biomarker-based diagnosis.