Bram Brookfield

Echocardiogram (transthoracic) 2026-10-02 11:15

Dr. Leopold Nairn (cardiology) · ejection fraction 30% (structured result)

Transthoracic echocardiogram. Left ventricle moderately dilated with moderate global hypokinesis. Left ventricular ejection fraction 30% by biplane method. Moderate mitral regurgitation. Estimated right ventricular systolic pressure 42 mmHg.
Chest X-ray, 2 views 2026-04-15 15:00

Dr. Petra Quill (radiology)

Enlarged cardiac silhouette. Small bilateral pleural effusions. Mild interstitial edema.
Echocardiogram (transthoracic) 2025-06-09 10:30

Dr. Leopold Nairn (cardiology) · ejection fraction 35% (structured result)

Transthoracic echocardiogram. Left ventricle mildly dilated with global hypokinesis. Left ventricular ejection fraction estimated at 35%. Mild mitral regurgitation. Normal right ventricular size.

“Draft · pending review” means the definition awaits approval by your clinical and coding reviewers.

Needs a look Heart pumping fraction (ejection fraction, EF) Draft · pending review

The note says CHF; the record has an ejection fraction of 30% on 2026-10-02 (earlier 35% on 2025-06-09). The note does not state the type.

Note read by: AI reader and rule reader agree · AI reader quoted CHF exacerbation

Evidence from the record (2)

Ejection fraction 30% · echocardiogram 2026-10-02 (transthoracic, biplane): Left ventricular ejection fraction 30% by biplane method. (Dr. Leopold Nairn (cardiology))
Ejection fraction 35% · echocardiogram 2025-06-09 (transthoracic, visual estimate): Left ventricular ejection fraction estimated at 35%. (Dr. Leopold Nairn (cardiology))

Acuity indicators in the record (7): evidence only, acuity is your judgement

Documented 2026-11-11 (nursing admission assessment): orthopnea (sleeps on two pillows)
Documented 2026-11-11 (nursing admission assessment): bilateral ankle edema, 2+
NT-proBNP 4150 pg/mL on 2026-11-11; previous 880 on 2026-08-08
Weight 86.1 kg on 2026-11-12; 82.9 kg on 2026-11-04 (change +3.2 kg)
Intravenous furosemide 40 mg twice daily ordered 2026-11-11 (active inpatient order)
Earlier admission 2026-04-15, 4 days: Shortness of breath and leg swelling; treated with intravenous furosemide
Acuity words in the note: exacerbation

Show in the note Reports

Options

Choose wording yourself, or none. Nothing is pre-selected; the list and its order are the same for every patient.

Met / not met only says whether the recorded value falls inside that definition's range. It is not a recommendation; the diagnosis is your judgement.

Needs: latest ejection fraction 40% or lower Record: latest 30% on 2026-10-02 · ✓ met
Needs: latest ejection fraction 41% to 49% Record: latest 30% on 2026-10-02 · ✗ not met
Needs: latest ejection fraction 50% or higher Record: latest 30% on 2026-10-02 · ✗ not met
Needs: an earlier ejection fraction of 40% or lower, the latest above 40%, and a rise of at least 10 points Record: earlier 35% on 2025-06-09, latest 30% on 2026-10-02 (change -5 points) · ✗ not met

One click places the wording you choose in the unsigned draft as a new line at the end of the assessment (your existing wording is not changed), highlighted, for you to edit or undo before signing. Your choice and the evidence shown are recorded.

Provenance

This check is stored and can be re-run to the same result.
Inputs: 8 record items, listed under Evidence above.
Readers: AI reader and rule reader agree
What happened so far: No response yet · shown 1 time before on this visit
Offer OF-000040 in the provenance record

Reference ids (for audit)

Definition version front_hf_ef_type@1.0 · run FRUN-00045 · replay ea4574ea385b…
Input ids: ECHO-P29-2, ECHO-P29-1, SX-P29-1, SX-P29-2, NP-P29-2, WT-P29-5, RX-P29-2, ADM-P29-1

Who read the note

Rule reader: a fixed word list, always on.
AI reader: openrouter · openai/gpt-6.1-terra. It may only quote the note; its quotes are checked character by character and must agree with the rule reader.
The results side (values, dates, definition) never depends on either reader.

Reference ids (for audit)

Rule reader word list: front-lexicon 1.0
AI reader: openrouter · openai/gpt-6.1-terra, version openai/gpt-6.1-terra; task exactdx.front_statements@1

Published definition and source

Clinical implications of the universal definition for the prevention and treatment of heart failure

definition version 1.0

Chandramouli C, Stewart S, Almahmeed W, Lam CSP (Clinical Cardiology) · 2022 · Section 1.3 'New universal definition' (classification by left ventricular ejection fraction) · source

Licence: open licence (Creative Commons Attribution 4.0), attribution: Chandramouli C, Stewart S, Almahmeed W, Lam CSP. Clinical implications of the universal definition for the prevention and treatment of heart failure. Clin Cardiol 2022;45(Suppl 1):S2-S12. doi:10.1002/clc.23842. Licensed under CC BY 4.0.. Source checked: opened (2026-11-14).

Categories by ejection fraction: 40% or lower; 41% to 49%; 50% or higher; improved (earlier 40% or lower, now above 40%, a rise of at least 10 points). Acuity is a clinical judgement: indicators are shown, nothing is concluded.

Edition note: The 2021 categories are shown as the 2021 edition. A 2026 second universal definition reportedly drops fixed cut-offs between reduced and preserved ejection fraction while keeping the improved category (summary of an openly licensed editorial; the consensus document itself was not opened). Clinical decision needed before release.

Edition note: A federal cross-check (NHLBI, 2022) describes reduced ejection fraction as below 40%, not 40% or lower: the boundary at exactly 40% differs between sources.

See also: Universal definition and classification of heart failure (2021); Second universal definition of heart failure (2026); Accelerating heart failure research (2022); ICD-10-CM FY2027 tabular list and index (2026).

Draft definition: pending clinical and coding review. No endorsement by the cited bodies is implied.

Reference ids (for audit)

Definition key front_hf_ef_type@1.0

Relevant history

14 related items from the whole chart for shortness of breath and leg swelling · related terms for shortness of breath or leg swelling. Your own words first, then related terms; newest first within each.

Earlier notes 5

Cardiology clinic visit 2026-08-08

S: Ankle swelling worse in the evenings; (Dr. Leopold Nairn)

Matched on: swelling (your words) · breath (your words) · Cardiology (related service) · edema (related word)
Discharge summary 2026-04-19

Admitted for shortness of breath and leg swelling over one week. (Dr. Anselm Hart)

Matched on: leg swelling (your words) · shortness (your words) · breath (your words) · furosemide (related medicine (loop diuretic))
Cardiology clinic visit 2025-06-14

New patient visit for exertional shortness of breath. (Dr. Leopold Nairn)

Matched on: shortness (your words) · breath (your words) · Cardiology (related service) · Echocardiogram (related test)
Admission history and physical 2026-11-11

Past history: Atrial fibrillation, Osteoarthritis, Hyperlipidemia, Insomnia. (Dr. Anselm Hart)

Matched on: Atrial fibrillation (related problem)
Clinic visit note 2026-04-25

Atrial fibrillation: stable; (Dr. Imogen Vale)

Matched on: Atrial fibrillation (related problem)

Results 1

NT-proBNP 2026-11-11

4150 pg/mL on 2026-11-11; 880 pg/mL on 2026-08-08

Matched on: NT-proBNP (related test)

Imaging and reports 3

Echocardiogram (transthoracic) 2026-10-02

Left ventricular ejection fraction 30% by biplane method. (Dr. Leopold Nairn (cardiology))

Matched on: Echocardiogram (related test) · ejection fraction (related test)
Chest X-ray, 2 views 2026-04-15

Mild interstitial edema. (Dr. Petra Quill (radiology))

Matched on: Chest X-ray (related test) · edema (related word)
Echocardiogram (transthoracic) 2025-06-09

Left ventricular ejection fraction estimated at 35%. (Dr. Leopold Nairn (cardiology))

Matched on: Echocardiogram (related test) · ejection fraction (related test)

Problem list 2

Chronic · since 2016-11 2026-11-11

Atrial fibrillation

Matched on: Atrial fibrillation (related problem)
Chronic · since 2025-06 2026-11-11

Heart failure

Matched on: Heart failure (related problem)

Medications 3

Active · Inpatient order · started 2026-11-11 2026-11-11

Furosemide: 40 mg IV twice daily

Matched on: Furosemide (related medicine (loop diuretic))
On hold · Home medication · started 2025-10-07 2025-10-07

Furosemide: 20 mg tablet · 1 by mouth daily (home; held while on IV)

Matched on: Furosemide (related medicine (loop diuretic))
Active · Home medication · started 2025-06-14 2025-06-14

Carvedilol: 12.5 mg tablet · 1 by mouth twice daily

Matched on: Carvedilol (related medicine (beta-blocker))

AI-suggested terms only widen the search; every item is a real chart item quoted from its own text.

Other checks 2

Other measurements checked against published definitions (the extended set).

Agrees: nothing to do Kidney filtering rate (eGFR) over time

Kidney results 201 days apart are 60 or above (filtering rate 75.4 on 2026-04-25 and 71.3 on 2026-11-12) and the note doesn't mention kidney function.

Show the results
Agrees: nothing to do Creatinine change during this stay

Creatinine did not rise enough (admission 1.05, peak 1.1 mg/dL) and the note doesn't mention a change.

Show the results

Details

Thresholds

Heart pumping fraction (ejection fraction, EF): Categories by ejection fraction: 40% or lower; 41% to 49%; 50% or higher; improved (earlier 40% or lower, now above 40%, a rise of at least 10 points). Acuity is a clinical judgement: indicators are shown, nothing is concluded.
Creatinine change during this stay: Threshold: creatinine up by 0.3 mg/dL within 48 hours, or to 1.5 times an earlier value. Urine output is not checked.

Rules and published sources

ckd_epi_2009@1.0 Levey et al., Ann Intern Med 2009;150:604-12 (2009 eGFR equation, drift check) · source
ckd_epi_2021@1.0 Inker et al., N Engl J Med 2021;385:1737-49 (2021 race-free eGFR equation) · source
kdigo_aki_2012@1.1 KDIGO 2012 guideline, Kidney Int Suppl 2012;2:1-138 (Rec 2.1.1-2.1.2, Table 2) · source
kdigo_ckd_2024@1.1 KDIGO 2024 guideline, Kidney Int 2024;105(4S):S117-S314 (G/A categories, >3 months) · source
kidney_compare@1.1 this tool's comparison rules (both directions) · source
kidney_exclusions@1.0 KDIGO 2024 guideline, limitations of creatinine-based eGFR (muscle mass, pregnancy, kidney replacement); local list · source
lab_units@1.1 KDIGO 2012 and 2024 guidelines, unit conversion (creatinine 1 mg/dL = 88.4 umol/L; ACR 1 mg/mmol = 8.84 mg/g) · source
front_hf_ef_type@1.0 draft, pending review

Record

Check RUN-00045 · kidney-engine 2.0 · replay efaafa4eb155…. Data for this panel (JSON).

Specificity check FRUN-00045 · front-engine 1.2 · replay ea4574ea385b….

Library check LRUN-00045 · library_default_set@1.1 · library-engine 1.1 · replay f84b0817cdf6….

Decision support only: you decide and you write the note. Nothing is inserted unless you click it. DataCrafters 1.0.0 · data as of Fri Nov 13, 2026 04:55 PM

Reports

Echocardiogram (transthoracic) 2026-10-02 11:15

Chest X-ray, 2 views 2026-04-15 15:00

Echocardiogram (transthoracic) 2025-06-09 10:30