Is there a clinically meaningful difference in patient reported dyspnea in acute heart failure? An analysis from URGENT Dyspnea

Pang, Peter S.; Lane, Kathleen A.; Tavares, Miguel; Storrow, Alan B.; Shen, Changyu; Peacock, W. Frank; Nowak, Richard M.; Mebazaa, Alexandre; Laribi, Sai͏̈d; Hollander, Judd E.; Gheorghiade, Mihai; Collins, Sean P.

doi:10.1016/j.hrtlng.2017.03.003

Cited by 16 publications

(11 citation statements)

References 27 publications

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“…Therefore, we suggest that changes of at least 20 mm in VAS score and 2 points in NRS score represent clinically meaningful changes of dyspnea intensity in the studied population. The clinically meaningful change in the VAS score for dyspnea was determined to be 22 mm for acute exacerbation of asthma and 10.5 mm or 21.1 mm for heart failure . Our results for cancer‐related dyspnea support those of these reports for nonmalignant diseases.…”

Section: Discussionsupporting

confidence: 85%

Effects of Oral Morphine on Dyspnea in Patients with Cancer: Response Rate, Predictive Factors, and Clinically Meaningful Change (CJLSG1101)

et al. 2019

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Background Although the efficacy of parenteral morphine for alleviating dyspnea has been previously demonstrated in several studies, little is known regarding the efficacy of oral morphine for dyspnea among patients with cancer, including its response rate and predictive factors of effectiveness. Therefore, the aim of this study was to clarify the effectiveness of oral morphine on dyspnea in patients with cancer and elucidate the predictive factors of its effectiveness. Subjects, Materials, and Methods In this multicenter prospective observational study, we investigated the change in dyspnea intensity in patients with cancer before and after the administration of oral morphine by using a visual analog scale (VAS). We also administered a self‐assessment questionnaire to determine whether the patients believed oral morphine was effective. Results Eighty patients were enrolled in the study, and 71 of these patients were eligible. The least square mean of the VAS scores for dyspnea intensity was 53.5 at baseline, which decreased significantly to 44.7, 40.8, and 35.0 at 30, 60, and 120 minutes after morphine administration, respectively. Fifty‐four patients (76.1%) reported that oral morphine was effective on the self‐assessment questionnaire. Among the background factors, a high score for “sense of discomfort” on the Cancer Dyspnea Scale (CDS) and a smoking history of fewer pack‐years were associated with greater effectiveness. Conclusion Oral morphine was effective and feasible for treating cancer‐related dyspnea. A higher score for “sense of discomfort” on the CDS and a smaller cumulative amount of smoking may be predictive factors of the effectiveness of oral morphine. Implications for Practice This study demonstrated that oral morphine was effective in alleviating cancer‐related dyspnea due to multiple factors including primary lung lesions, airway narrowing, and pleural effusion. Approximately 76% of patients reported that oral morphine was effective. A higher score for “sense of discomfort” on the Cancer Dyspnea Scale and a lower cumulative amount of smoking may be predictive factors for the effectiveness of oral morphine. Interestingly, respiratory rates in patients who reported the morphine to be effective decreased significantly after oral morphine administration, unlike the respiratory rates in “morphine‐ineffective” patients.

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Section: Discussionsupporting

confidence: 85%

Effects of Oral Morphine on Dyspnea in Patients with Cancer: Response Rate, Predictive Factors, and Clinically Meaningful Change (CJLSG1101)

et al. 2019

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“…This sample size will have at least 80% power to detect a reduction of one SD using one-sided two-sample t-test at a significance level of 0.05. Further, a cardiologist, pulmonologist, and two palliative physicians experienced in caring for patients with EOL breathlessness agreed that even a 0.5 standard deviation (SD) improvement is an indication of best possible management of advanced HF breathlessness [29]. This sample size is also accounted for an expected 20% attrition (due to HF deaths).…”

Section: Methodsmentioning

confidence: 99%

Study protocol of coaching end-of-life palliative care for advanced heart failure patients and their family caregivers in rural appalachia: a randomized controlled trial

et al. 2019

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BackgroundHeart failure (HF) afflicts 6.5 million Americans with devastating consequences to patients and their family caregivers. Families are rarely prepared for worsening HF and are not informed about end-of-life and palliative care (EOLPC) conservative comfort options especially during the end stage. West Virginia (WV) has the highest rate of HF deaths in the U.S. where 14% of the population over 65 years have HF. Thus, there is a need to investigate a new family EOLPC intervention (FamPALcare), where nurses coach family-managed advanced HF care at home.MethodsThis study uses a randomized controlled trial (RCT) design stratified by gender to determine any differences in the FamPALcare HF patients and their family caregiver outcomes versus standard care group outcomes (N = 72). Aim 1 is to test the FamPALcare nursing care intervention with patients and family members managing home supportive EOLPC for advanced HF. Aim 2 is to assess implementation of the FamPALcare intervention and research procedures for subsequent clinical trials. Intervention group will receive routine standard care, plus 5-weekly FamPALcare intervention delivered by community-based nurses. The intervention sessions involve coaching patients and family caregivers in advanced HF home care and supporting EOLPC discussions based on patients’ preferences. Data are collected at baseline, 3, and 6 months. Recruitment is from sites affiliated with a large regional hospital in WV and community centers across the state.DiscussionThe outcomes of this clinical trial will result in new knowledge on coaching techniques for EOLPC and approaches to palliative and end-of-life rural home care. The HF population in WV will benefit from a reduction in suffering from the most common advanced HF symptoms, selecting their preferred EOLPC care options, determining their advance directives, and increasing skills and resources for advanced HF home care. The study will provide a long-term collaboration with rural community leaders, and collection of data on the implementation and research procedures for a subsequent large multi-site clinical trial of the FamPALcare intervention. Multidisciplinary students have opportunity to engage in the research process.Trial registrationClinicalTrials.gov NCT04153890, Registered on 4 November 2019

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“…The magnitude of VAS-3 related breathing comfort improvement on MAD (the 42% observed improvement corresponds to 21 mm) was higher than the VAS-related dyspnoea improvement previously described in acute heart failure (Pang et al, 2017). In this study a 10.5 mm change in VAS in the upright position, and 14.5 mm in the supine position were considered as minimal clinically important differences within six hours after initiation of treatment.…”

Section: Blunted Respiratory Sensations In Osas Patientsmentioning

confidence: 52%

Mandibular advancement reveals long-term suppression of breathing discomfort in patients with obstructive sleep apnea syndrome

Attali

Collet

Jacq

et al. 2019

Respiratory Physiology & Neurobiology

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Isabelle Arnulf, et al.. Mandibular advancement reveals long-term suppression of breathing discomfort in patients with obstructive sleep apnea syndrome. Respiratory Physiology and Neurobiology, Elsevier, 2019, 263, pp. AbstractObstructive sleep apnoea syndrome (OSAS) patients do not report breathing discomfort in spite of abnormal upper airway mechanics. We studied respiratory sensations in OSAS patients without and with mandibular advancement device (MAD).Fifty-seven moderate to severe non obese OSAS patients were asked about breathing discomfort using visual analogue scales (VAS) in the sitting position (VAS-1), after lying down (VAS-2), then with MAD (VAS-3). Awake critical closing pressure (awake Pcrit) was measured in 15 patients without then with MAD.None of the patients reported breathing discomfort when sitting but 19 patients (33%) did when lying (VAS-2: -20% or less). A feeling of "easier breathing" with MAD was observed and was more marked in patients reporting breathing discomfort when supine (VAS-3: +66.0% [49.0; 89.0]) than in those not doing so (VAS-3: +28.5% [1.0; 56.5], p=0.007). MAD-induced change in awake Pcrit was correlated to VAS-3.In conclusion, MAD revealed "latent dyspnea" related to the severity of upper airways mechanics abnormalities in OSAS patients.

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Is there a clinically meaningful difference in patient reported dyspnea in acute heart failure? An analysis from URGENT Dyspnea

Cited by 16 publications

References 27 publications

Effects of Oral Morphine on Dyspnea in Patients with Cancer: Response Rate, Predictive Factors, and Clinically Meaningful Change (CJLSG1101)

Effects of Oral Morphine on Dyspnea in Patients with Cancer: Response Rate, Predictive Factors, and Clinically Meaningful Change (CJLSG1101)

Study protocol of coaching end-of-life palliative care for advanced heart failure patients and their family caregivers in rural appalachia: a randomized controlled trial

Mandibular advancement reveals long-term suppression of breathing discomfort in patients with obstructive sleep apnea syndrome

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