Assessment of Dyspnea in Acute Decompensated Heart Failure

Hernandez, Adrian F.; O’Connor, Christopher M.; Starling, Randall C.; Proulx, Guy; Weiss, Morris M.; Bakal, Jeffrey A.; Califf, Robert M.; McMurray, John J.V.; Armstrong, Paul W.

doi:10.1016/j.jacc.2011.11.061

Cited by 37 publications

(13 citation statements)

References 33 publications

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“…Previous studies explored associations between objective measures of dyspnea evaluation (eg, peak expiratory flow rate) and patient-reported measures of dyspnea by Likert scale. 19 To our knowledge, no study has demonstrated that objective measures of dyspnea at baseline adequately quantify patient-reported dyspnea severity on admission. These data in combination with our analysis support the utility of assessing patient-reported dyspnea severity on admission for acute HF.…”

Section: Discussionmentioning

confidence: 99%

Relation of Dyspnea Severity on Admission for Acute Heart Failure With Outcomes and Costs

Mentz

Sharma

et al. 2015

The American Journal of Cardiology

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Hospitalization for heart failure (HF) is frequently related to dyspnea, yet associations between dyspnea severity, outcomes, and health care costs are unknown. We aimed to describe characteristics of patients hospitalized for acute HF by dyspnea severity and to examine associations between dyspnea severity, outcomes and costs. We linked registry data for patients hospitalized for HF with Medicare claims to evaluate dyspnea and outcomes among patients 65 years and older. We classified patients by patient-reported dyspnea severity at admission. Outcomes included length of stay, mortality 30 days after admission, and days alive and out of the hospital, readmission, and Medicare payments 30 days after discharge. Of 48,616 patients with acute HF and dyspnea, 4022 (8.3%) had dyspnea with moderate activity, 19,619 (40.3%) with minimal activity, and 24,975 (51.4%) at rest. Patients with dyspnea with minimal activity or at rest had greater comorbidity, including renal insufficiency. Greater severity of baseline dyspnea was associated with mortality (moderate activity, 6.3%; minimal activity, 7.6%; at rest, 11.6%) and heart failure readmission (7.2%, 9.0%, and 9.4%). After multivariable adjustment, dyspnea at rest was associated with greater 30-day mortality and heart failure readmission, fewer days alive and out of the hospital, longer length of stay, and higher Medicare payments, compared to dyspnea with moderate activity. In conclusion, dyspnea at rest on presentation was associated with greater mortality, readmission, length of stay, and health care costs among patients hospitalized with acute HF.

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Section: Discussionmentioning

confidence: 99%

Relation of Dyspnea Severity on Admission for Acute Heart Failure With Outcomes and Costs

Mentz

Sharma

et al. 2015

The American Journal of Cardiology

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“…(95,96) Assessment of dyspnea is not only plagued by its difficult recognition but also by its lack of an objective gold standard for validation. (97,98) Studies have repeatedly failed to link patient-reported dyspnea to objective measurements such as pulmonary-capillary wedge pressure, left ventricular ejection fraction, and cardiac output. (18,31,99) Similarly, dyspnea does not correlate well with spirometry or pulse oximetry, though one trial suggested that the use of peak expiratory flow rate may be helpful.…”

Section: Dyspneamentioning

confidence: 99%

Symptom burden in heart failure: assessment, impact on outcomes, and management

et al. 2016

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Evidence-based management has improved long-term survival in patients with heart failure (HF). However, an unintended consequence of increased longevity is that patients with HF are exposed to a greater symptom burden over time. In addition to classic symptoms such as dyspnea and edema, patients with HF frequently suffer additional symptoms such as pain, depression, gastrointestinal distress, and fatigue. In addition to obvious effects on quality of life, untreated symptoms increase clinical events including emergency department visits, hospitalizations, and long-term mortality in a dose-dependent fashion. Symptom management in patients with HF consists of two key components: comprehensive symptom assessment and sufficient knowledge of available approaches to alleviate the symptoms. Successful treatment addresses not just the physical but also the emotional, social, and spiritual aspects of suffering. Despite a lack of formal experience during cardiovascular training, symptom management in HF can be learned and implemented effectively by cardiology providers. Co-management with palliative medicine specialists can add significant value across the spectrum and throughout the course of HF.

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“…Moreover, dyspnea correlates poorly with in-hospital worsening HF and postdischarge events (e.g., readmission and mortality) making it difficult to rely on as the sole measure of improvement. 126–129 Maneuvers that illicit cardiac stress through provocation with position change (i.e., seated to supine) or physical exertion (i.e., walk tests) may help delineate more subtle effects of AHF on dyspnea and thus serve as more definitive measures of clinical improvement, but have yet to be tested in prospective trials. 130 Further, other HF symptoms, such as fatigue and body swelling, may be as meaningful as dyspnea to patients and important patient-centered endpoints to explore.…”

Section: Unanswered Questions and Future Research Agendamentioning

confidence: 99%

Early Management of Patients With Acute Heart Failure: State of the Art and Future Directions—A Consensus Document from the SAEM/HFSA Acute Heart Failure Working Group

Collins

Storrow

Levy

et al. 2014

Academic Emergency Medicine

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Heart failure (HF) afflicts nearly 6 million Americans, resulting in 1 million emergency department (ED) visits and over 1 million annual hospital discharges. The majority of inpatient admissions originate in the ED; thus, it is crucial that emergency physicians and other providers involved in early management understand the latest developments in diagnostic testing, therapeutics, and alternatives to hospitalization. This article discusses contemporary ED management as well as the necessary next steps for ED-based acute HF research.

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Assessment of Dyspnea in Acute Decompensated Heart Failure

Cited by 37 publications

References 33 publications

Relation of Dyspnea Severity on Admission for Acute Heart Failure With Outcomes and Costs

Relation of Dyspnea Severity on Admission for Acute Heart Failure With Outcomes and Costs

Symptom burden in heart failure: assessment, impact on outcomes, and management

Early Management of Patients With Acute Heart Failure: State of the Art and Future Directions—A Consensus Document from the SAEM/HFSA Acute Heart Failure Working Group

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