Purpose
To determine the validity of Framingham criteria for heart failure diagnosis in a high-altitude population.
Material and Methods
This is a prospective, observational, descriptive, and transversal study. The study population was comprised of 97 inpatients hospitalized at Internal Medicine Service at Hospital Nacional del Centro - EsSalud Huancayo, located at an altitude of 3240 m above sea level. Patients included presented with dyspnea on exertion or at least one major Framingham criterion. Echocardiograms were performed with a Sonos 1000 echocardiographer, with color Doppler, B-mode and M-mode techniques. Dichotomous variables were analyzed by Mantel – Haenszel chi square test. A p <0.05 was considered significant.
Results
Most patients were male (51.6%). Subject age was 69.5 ± [SD tk] (20-90) years (mean ± SD with range). A total of 73.2% of patients were elderly (n=71). The most frequent major criteria found were: cardiomegaly (88.9%), hepatojugular reflux (79.2%) and jugular engorgement (69.4%). The most important minor criteria were: exertional dyspnea (91.7%), pleural effusion (69.4%) and lower limb edema (58.3%). Framingham diagnostic criteria were present in 98.6% of patients with heart failure but had a specificity of only 12%. The specificity rose to 76% by using 4 major criteria and to 100% when using 5 criteria. Unfortunately, the sensitivity fell at the same time to 62.5% and 31.9%, respectively.
Conclusions
Framingham criteria are highly sensitive but nonspecific for the diagnosis of heart failure in high-altitude populations.