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.
References:
- 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]
- 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: Jul 17, 2006
