Letters Section Editor: Robert M. Golub, MD, Senior Editor.
In Reply: Our study had a relatively narrow focus, and its primary purpose was to systematically review published studies that examined the utility of various findings (from history, physical examination, chest roentgenogram, electrocardiogram, and B-type natriuretic peptide testing) to predict clinical heart failure as the cause of dyspnea in the emergency department. Specifically, we did not include studies that only assessed the utility of findings to predict a reduced left ventricular ejection fraction, because this is a very different clinical question. Furthermore, we did not include studies that assessed patients outside of the emergency department because we believed that the location of the study (cardiac catheterization laboratory, general outpatient medical clinic, subspecialty medical clinic, emergency department, etc) and the consequent different “patient mix” would substantially affect the clinical utility of the findings. These are the reasons the studies cited by Dr Schlegel1,2 were not included in our analysis.
Ayas NT, Wang CS, FitzGerald JM. Dyspnea and Heart Failure in the Emergency Department—Reply. JAMA. 2006;295(10):1122-1123. doi:10.1001/jama.295.10.1122-b