Boston Criteria for Diagnosing Heart Failure

The Boston criteria uses the information from history, physical examination, and chest radiography to categorize the diagnosis of heart failure.

Criterion Point value
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 per minute; 2 points if more than 110 beats per minute) 1 o 2
Jugular venous elevation (2 points if greater than 6 cm H2O; 3 points if greater than 6 cm H2O plus hepatomegaly or edema) 2 o 3
Lung crackles (1 point if basilar; 2 points if more than basilar) 1 o 2
Wheezing 3
Third heart sound 3
Category III: chest radiography
Alveolar pulmonary edema 4
Interstitial pulmonary edema 3
Bilateral pleural effusion 3
Cardiothoracic ratio greater than 0.50 3
Upper zone flow redistribution 2

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.



  1. Marantz PR, Tobin JN, Wassertheil-Smoller S, Steingart RM, Wexler JP, Budner N, Lense L, Wachspress J. The relationship between left ventricular systolic function and congestive heart failure diagnosed by clinical criteria. Circulation. 1988 Mar;77(3):607-12. [Medline]
  2. Remes J, Miettinen H, Reunanen A, Pyorala K. Validity of clinical diagnosis of heart failure in primary health care. Eur Heart J. 1991 Mar;12(3):315-21. [Medline]

Created: July 17, 2006