Framingham HF Criteria

Diagnose congestive heart failure clinically. Requires 2 major OR 1 major + 2 minor criteria.

Indication

Diagnose congestive heart failure clinically. Requires 2 major OR 1 major + 2 minor criteria.

id: maj_pnd; label: MAJOR: Paroxysmal nocturnal dyspnea; type: yesno; points: 1
id: maj_orthopnea; label: MAJOR: Orthopnea (≥3 pillows); type: yesno; points: 1
id: maj_jvp; label: MAJOR: Elevated JVP; type: yesno; points: 1
id: maj_rales; label: MAJOR: Pulmonary rales; type: yesno; points: 1
id: maj_cardiomegaly; label: MAJOR: Cardiomegaly on CXR; type: yesno; points: 1
id: maj_edema; label: MAJOR: Acute pulmonary edema on CXR; type: yesno; points: 1
id: maj_s3; label: MAJOR: S3 gallop; type: yesno; points: 1
id: maj_hjr; label: MAJOR: Hepatojugular reflux; type: yesno; points: 1
id: maj_weightloss; label: MAJOR: Weight loss ≥4.5kg in 5 days with treatment; type: yesno; points: 1
id: min_ankle; label: MINOR: Bilateral ankle edema; type: yesno; points: 1
id: min_cough; label: MINOR: Nocturnal cough; type: yesno; points: 1
id: min_doe; label: MINOR: Dyspnea on exertion; type: yesno; points: 1
id: min_hepatomegaly; label: MINOR: Hepatomegaly; type: yesno; points: 1
id: min_effusion; label: MINOR: Pleural effusion; type: yesno; points: 1
id: min_tachy; label: MINOR: Tachycardia HR >120 bpm; type: yesno; points: 1
id: min_vitalcap; label: MINOR: Vital capacity decreased 1/3 from max; type: yesno; points: 1

Framingham criteria are clinical — BNP/NT-proBNP adds objective biomarker confirmation
Echocardiography is still required to assess systolic vs diastolic dysfunction
BNP >500 pg/mL has high sensitivity for acute decompensated HF
BNP <100 pg/mL effectively rules out HF as the cause of dyspnea

McKee PA et al. NEJM 1971; Criteria Committee of NYHA 1994. Last reviewed: 2025-01-01