Unifying Concepts

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: Jul 17, 2006

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