Clinical recommendation	Evidence rating	References
The initial evaluation of patients with suspected heart failure should include a history and physical examination, laboratory assessment, chest radiography, and electrocardiography. Echocardiography can confirm the diagnosis.	C	3
A displaced cardiac apex, a third heart sound, and chest radiography findings of pulmonary venous congestion or interstitial edema are good predictors to rule in the diagnosis of heart failure.	C	21, 23
Systolic heart failure can be effectively ruled out with a normal B-type natriuretic peptide or N-terminal pro–B-type natriuretic peptide level.	C	21–23, 25, 27, 28
Systolic heart failure can be effectively ruled out when the Framingham criteria are not met.	C	17, 29