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Dyspnoea in patients with acute heart failure: an analysis of its clinical course, determinants, and relationship to 60‐day outcomes in the PROTECT pilot study
Author(s) -
Metra Marco,
Cleland John G.,
Weatherley Beth Davison,
Dittrich Howard C.,
Givertz Michael M.,
Massie Barry M.,
O'Connor Christopher M.,
Ponikowski Piotr,
Teerlink John R.,
Voors Adriaan A.,
Cotter Gad
Publication year - 2010
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 - 10.1093/eurjhf/hfq021
Subject(s) - medicine , heart failure , post hoc analysis , incidence (geometry) , emergency medicine , optics , physics
Aims Dyspnoea is the most common symptom leading to hospitalization for acute heart failure (AHF). Its early and persistent relief is an important goal of therapy, but little is known about its course, determinants, and prognostic significance. Methods and results In a post hoc analysis, we studied changes in dyspnoea and in‐hospital course in 303 subjects with AHF enrolled in the PROTECT pilot trial. Changes in dyspnoea were assessed by patient self‐report using a seven‐point Likert scale daily to discharge and at Days 7 and 14. We defined dyspnoea relief as a moderate to marked improvement of dyspnoea at both 24 and 48 h, and treatment success as dyspnoea relief without worsening HF or renal function or death during the first 7 days. Dyspnoea relief occurred in 54% of the patients, while treatment success was achieved in 44% of the patients. By Day 14, only 75% of patients reported a moderate or marked improvement in dyspnoea. Both dyspnoea relief and treatment success were associated with greater improvement in signs of congestion, shorter hospitalization duration, and a lower 60‐day mortality rate. Treatment success, but not dyspnoea relief, was also associated with a lower incidence of 60‐day death or re‐hospitalization for HF or renal failure. Conclusion Half of patients admitted for AHF do not have substantial improvement in dyspnoea at 24 h and 25% do not have substantial improvement at 7 and 14 days from admission. Dyspnoea relief and treatment success are associated with shorter length of stay and lower 60‐day mortality. These analyses should be confirmed in larger studies.