Evaluation of Novel Metrics of Symptom Relief in Acute Heart Failure: The Worst Symptom Score

Omar F. AbouEzzeddine, Yee Weng Wong, Robert J. Mentz, Sadi S. Raza, Jose Nativi-Nicolau, Robb D. Kociol, Steven E. McNulty, Kevin J. Anstrom, Adrian F. Hernandez, Margaret M. Redfield

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Objective To characterize a novel “worst”-symptom visual analogue scale (WS-VAS) versus the traditional dyspnea visual analogue scale (DVAS) in an acute heart failure (AHF) trial. Background AHF trials assess symptom relief as a pivotal endpoint with the use of dyspnea scores. However, many AHF patients' worst presenting symptom (WS) may not be dyspnea. We hypothesized that a WS-VAS may reflect clinical improvement better than DVAS in AHF. Methods and Results AHF patients (n = 232) enrolled in the Renal Optimization Strategies Evaluation in Acute Heart Failure (ROSE-AHF) Trial indicated their WS at enrollment and completed DVAS and WS-VAS at enrollment and 24, 48, and 72 hours. Dyspnea was the WS in 61%, body swelling in 29%, and fatigue in 10% of patients. Clinical characteristics differed by WS. In all patients, DVAS scores were higher (less severe symptoms) than WS-VAS and the change in WS-VAS over 72 hours was greater than the change in DVAS (P < .001). Changes in DVAS were smaller in patients with body swelling and fatigue than in patients with dyspnea as their WS (P = .002), whereas changes in the WS-VAS were similar regardless of patients' WS. Neither score, nor its change, was associated with available decongestion markers (change in N-terminal pro–B-type natriuretic peptide, weight or cumulative 72-hour urine volume). Conclusions Many AHF patients have symptoms other than dyspnea as their most bothersome symptom. The WS-VAS better reflects symptom improvement across the spectrum of AHF phenotypes. Symptom relief and decongestion were not correlated in this AHF study.

Original languageEnglish (US)
Pages (from-to)853-858
Number of pages6
JournalJournal of Cardiac Failure
Issue number11
StatePublished - Nov 1 2016


  • Acute heart failure
  • clinical trials
  • quality of life

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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