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Alternans of the Pulse Is Rarely an Alternans of Prognosis

      We read with interest the consensus statement on the universal definition and classification of heart failure, by Bozkurt et al.
      • Bozkurt B
      • Coats AJ
      • Tsutsui H
      • Abdelhamid M
      • Adamopoulos S
      • Albert N
      • et al.
      Universal definition and classification of heart failure: a report of the Heart Failure Society of America, Heart Failure Association of the European Society of Cardiology, Japanese Heart Failure Society and Writing Committee of the Universal Definition of Heart Failure.
      in the April 2021 issue of the Journal. However, we were surprised that an important physical examination finding of cardiac failure which is of prognostic significance, the pulsus alternans (PA), was not included in Table 6 (Symptoms and Signs of Heart Failure).
      • Bozkurt B
      • Coats AJ
      • Tsutsui H
      • Abdelhamid M
      • Adamopoulos S
      • Albert N
      • et al.
      Universal definition and classification of heart failure: a report of the Heart Failure Society of America, Heart Failure Association of the European Society of Cardiology, Japanese Heart Failure Society and Writing Committee of the Universal Definition of Heart Failure.
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