The grading of evidence (High, Moderate, Low, Very Low) and strength of recommendations (Strong or Conditional) are defined at the end of the "Major Recommendations" field.
Presentation and Detection of Heart Failure (HF) in Children
Symptom Severity and Recognition
- The New York Heart Association (NYHA)/Ross classiﬁcation is a suitable basis for symptom stratiﬁcation of patients with established chronic HF, but is not essential to establishing the diagnosis, or determining the prognosis of HF in children (Strong Recommendation, Moderate-Quality Evidence).
Values and preferences. This Recommendation places high value on the need for the development of reliable and valid prognostic indicators for pediatric HF.
- Underlying cardiac disease should be considered and excluded in younger infants with feeding difﬁculties and growth failure when primary gastrointestinal and other common causes have been ruled out, and in infants, toddlers, and children with chronic calorie, protein, or trace element deﬁciency (Strong Recommendation, Moderate-Quality Evidence).
Values and preferences. This Recommendation places a high value on early diagnosis of underlying HF in situations of ambiguous clinical symptoms and signs, or when uncertainty is present. Early and repeated cardiovascular examination of infants is mandated as the most valuable screening tool available. Expert evaluation is considered preferable in situations of uncertainty, notwithstanding the potential for unnecessary referral: the trade-off of missed diagnosis at an earlier stage of disease being of such signiﬁcant consequence to the patient and family.