There is no uniformly accepted clinical definition for congestive heart failure (CHF), although criteria have been published by various groups. There is also no Circulation 77, No. 3, 607-612, 1988. CONGESTIVE HEART FAILURE is among the most frequently encountered cardiac diagnoses. Prevalence of congestive heart failure is estimated to be 1% in the United States,1 and Framingham data gives an incidence rate of about 2 per 1000 persons per year.2 Only 50% of patients diagnosed as having congestive heart failure survive for 5 years.' It also has major impact in terms of morbidity and hospitalization; among elderly patients, it is the most common medical indication for hospitalization.3Epidemiologic studies in congestive heart failure have been hampered by the lack of uniform diagnostic criteria, relying instead on physician diagnosis of the disease. The Framingham Study2 created clinical criteria for diagnosing congestive heart failure (
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