Skip to main content

Table 1 Study protocol for prehospital clinical assessment of HF (modified Boston criteria)a

From: Combination of lung ultrasound (a comet-tail sign) and N-terminal pro-brain natriuretic peptide in differentiating acute heart failure from chronic obstructive pulmonary disease and asthma as cause of acute dyspnea in prehospital emergency setting

Criterion

 

Point valueb

Category I: History

Rest dyspnea

4

 

Orthopnea

4

 

Paroxysmal nocturnal dyspnea

3

 

Dyspnea while walking on level area

2

 

Dyspnea while climbing

1

Category II: Physical examination

Heart rate abnormality (1 point if 91 to 110 beats/minute;

2 points if more than 110 beats/minute)

1 or 2

 

Jugular venous elevation (2 points if greater than 5 cmH2O;

3 points if greater than 5 cmH2O plus hepatomegaly or edema)

2 or 3

 

Lung rales (1 point if basilar; 2 points if more than basilar)

1 or 2

 

Wheezing

3

 

Third heart sound

3

Category III: Additional

minor criteria

Hepatojugular reflux

1

 

ECG changes (HLV, old AMI or nonspecific ST-T changes, arrhythmia)

1

 

Night cough

1

 

Murmur

1

 

Without sputum and/or fever

1

 

Previous AMI, arrhythmia or HF

1

 

HF medications

1

  1. aBoston criteria [6]. HF, heart failure; ECG, electrocardiogram; HLV, hypertrophy of the left ventricle; AMI, acute myocardial infarction. bPoint value: no more than 4 points allowed from each of three categories; hence the composite score (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 8 to 12 points, "possible" at a score 5 to 7 points and "unlikely" at a score of 4 points or less.