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Chronic Congestive Heart Failure in Coronary Artery Disease: Clinical Criteria

WILLIAM R. HARLAN, M.D., F.A.C.P.; ALBERT OBERMAN, M.D., F.A.C.P.; RICHARD GRIMM, M.D.; and ROBERT A. ROSATI, M.D.
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▸Requests for reprints should be addressed to William R. Harlan, M.D.; G-1209 Towsley Center, University of Michigan Medical School; Ann Arbor, MI 48109.


Ann Arbor, Michigan; Birmingham, Alabama; and Durham, North Carolina


Ann Intern Med. 1977;86(2):133-138. doi:10.7326/0003-4819-86-2-133
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Congestive heart failure is a frequent and important manifestation of cardiovascular disease, but no uniform clinical criteria are available for use in epidemiologic studies. To develop diagnostic criteria, we related pertinent clinical findings to physiologic measures of left ventricular function in patients with coronary artery disease. When left ventricular end diastolic pressure or arteriovenous oxygen difference was used as the physiologic criterion, the following variables contributed significant (P < 0.01) information: heart volume, ventricular gallop, heart rate, and blood pressure. The most reliable and valid set of descriptors determined in one group was tested in a second group of 1306 patients who had been followed for 6 to 36 months after initial evaluation. The validity of the descriptors was confirmed, and patients identified as having heart failure by these criteria experienced a worse survival rate (P < 0.001). These criteria characterize patients likely to have impaired left ventricular function and a greater risk of death.

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