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Breathlessness at rest is not the dominant presentation of patients admitted with heart failure
Author(s) -
Shoaib Ahmad,
Waleed Mohammad,
Khan Saima,
Raza Ali,
Zuhair Mohamed,
Kassianides Xenophon,
Djahit Ayse,
Goode Kevin,
Wong Kenneth,
Rigby Alan,
Clark Andrew,
Cleland John
Publication year - 2014
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1002/ejhf.153
Subject(s) - medicine , heart failure , vital signs , heart rate , confidence interval , exertion , odds ratio , cardiology , blood pressure , respiratory rate , rest (music) , surgery
Aims Many assume that most patients hospitalized with heart failure ( HF ) are short of breath at rest ( SOBAR ). The National HF Audit for England and Wales suggests that this assumption is false, which has profound implications for management Methods and results A retrospective case‐note review was carried out of patients hospitalized with HF to determine how many present with shortness of breath at rest or are comfortable at rest but breathless on slight exertion ( CARBOSE ). Vital signs were tracked for 24 h and mortality for 180 days. Of 311 patients, those who were SOBAR (42%) had higher median heart rate ( HR ) (100 vs. 85 b.p.m.; P < 0.001), systolic blood pressure ( SBP ) (141 vs. 122 mmHg ; P < 0.001), and respiratory rate ( RR ) (24 vs. 18 breaths/min; P < 0.001) compared with those who were CARBOSE (56%). Vital signs changed little in those who were CARBOSE over the first 4–6 h, but SBP (141–128 mmHg ; P < 0.001), HR (100–90 b.p.m.; P = 0.002), and RR (24–20 breaths/min; P < 0.001) fell in those who were SOBAR . At presentation, SBP was >125 mmHg in 73% of patients who were SOBAR and in 46% who were CARBOSE , dropping to 52% and 37%, respectively, by 4–6 h. Mortality amongst those who were SOBAR and those who were CARBOSE was, respectively, 19% and 34% (odds ratio 2.29; P = 0.005, 95% confidence interval 1.29–4.06). Conclusion Many patients admitted with HF are CARBOSE . Shortness of breath at rest may be more alarming, but those who are CARBOSE have a worse prognosis, perhaps reflecting more severe right heart dysfunction. Clinical trials of hospitalized HF may inappropriately exclude patients if they focus on shortness of breath at rest rather than peripheral congestion.