TY - JOUR
T1 - Evaluation of a provocative dyspnea severity score in acute heart failure
AU - AbouEzzeddine, Omar F.
AU - Lala, Anuradha
AU - Khazanie, Prateeti P.
AU - Shah, Ravi
AU - Ho, Jennifer E.
AU - Chen, Horng H.
AU - Pang, Peter S.
AU - McNulty, Steven E.
AU - Anstrom, Kevin J.
AU - Hernandez, Adrian F.
AU - Redfield, Margaret M.
N1 - Funding Information:
This work was supported by grants from the National Heart, Lung, and Blood Institute (NHLBI) (coordinating center: U10 HL084904; regional clinical centers and Heart Failure Network Clinical Research Skills Development Cores : U01 HL084861, U10 HL110312, U109 HL110337, U01 HL084889, U01 HL084890, U01 HL084891, U10 HL110342, U10 HL110262, U01 HL084931, U10 HL110297, U10 HL110302, U10 HL110309, U10 HL110336, U10 HL110338). This work was also supported by the National Center for Advancing Translational Sciences (UL1TR000454, UL1TR000135, UL1RR025008, UL1TR000439) and the National Institute on Minority Health and Health Disparities (8 U54 MD007588). Dr. Omar AbouEzzeddine was funded by the NIH Training Grant (T-91160) and the HFCRN Skills Development Core (HL 84907). Dr. Prateeti P. Khazanie was supported by grant 5T32HL69749-10 from the National Heart, Lung, and Blood Institute. The authors are solely responsible for the design and conduct of this study, all study analyses, the drafting and editing of the paper and its final contents.
Publisher Copyright:
© 2015 Elsevier Inc. All rights reserved.
PY - 2016/2
Y1 - 2016/2
N2 - Background The acute heart failure (AHF) Syndromes International Working Group proposed that dyspnea be assessed under standardized, incrementally provocative maneuvers and called for studies to assess the feasibility of this approach. We sought to assess the feasibility and statistical characteristics of a novel provocative dyspnea severity score (pDS) versus the traditional dyspnea visual analog scale (DVAS) in an AHF trial. Methods At enrollment, 24, 48 and 72 hours, 230 ROSE-AHF patients completed a DVAS. Dyspnea was then assessed with 5-point Likert dyspnea scales administered during 4 stages (A: upright-with O2, B: upright-without O2, C: supine-without O2 and D: exercise-without O2). Patients with moderate or less dyspnea were eligible for the next stage. Results At enrollment, oxygen withdrawal and supine provocation were highly feasible (≥97%), provoking more severe dyspnea (≥1 Likert point) in 24% and 42% of eligible patients, respectively. Exercise provocation had low feasibility with 38% of eligible patients unable to exercise due to factors other than dyspnea. A pDS was constructed from Likert scales during the 3 feasible assessment conditions (A-C). Relative to DVAS, the distribution of the pDS was more skewed with a high "ceiling effect" at enrollment (23%) limiting sensitivity to change. Change in pDS was not related to decongestion or 60-day outcomes. Conclusions Although oxygen withdrawal and supine provocation are feasible and elicit more severe dyspnea, exercise provocation had unacceptable feasibility in this AHF cohort. The statistical characteristics of a pDS based on feasible provocation measures do not support its potential as a robust dyspnea assessment tool in AHF.
AB - Background The acute heart failure (AHF) Syndromes International Working Group proposed that dyspnea be assessed under standardized, incrementally provocative maneuvers and called for studies to assess the feasibility of this approach. We sought to assess the feasibility and statistical characteristics of a novel provocative dyspnea severity score (pDS) versus the traditional dyspnea visual analog scale (DVAS) in an AHF trial. Methods At enrollment, 24, 48 and 72 hours, 230 ROSE-AHF patients completed a DVAS. Dyspnea was then assessed with 5-point Likert dyspnea scales administered during 4 stages (A: upright-with O2, B: upright-without O2, C: supine-without O2 and D: exercise-without O2). Patients with moderate or less dyspnea were eligible for the next stage. Results At enrollment, oxygen withdrawal and supine provocation were highly feasible (≥97%), provoking more severe dyspnea (≥1 Likert point) in 24% and 42% of eligible patients, respectively. Exercise provocation had low feasibility with 38% of eligible patients unable to exercise due to factors other than dyspnea. A pDS was constructed from Likert scales during the 3 feasible assessment conditions (A-C). Relative to DVAS, the distribution of the pDS was more skewed with a high "ceiling effect" at enrollment (23%) limiting sensitivity to change. Change in pDS was not related to decongestion or 60-day outcomes. Conclusions Although oxygen withdrawal and supine provocation are feasible and elicit more severe dyspnea, exercise provocation had unacceptable feasibility in this AHF cohort. The statistical characteristics of a pDS based on feasible provocation measures do not support its potential as a robust dyspnea assessment tool in AHF.
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U2 - 10.1016/j.ahj.2015.10.009
DO - 10.1016/j.ahj.2015.10.009
M3 - Article
C2 - 26856213
AN - SCOPUS:84960158154
SN - 0002-8703
VL - 172
SP - 34
EP - 41
JO - American heart journal
JF - American heart journal
ER -