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

Authors

Peter S. Pang
Kathleen A. Lane
Miguel Tavares
Alan B. Storrow
Changyu Shen
W F. PeacockFollow
Richard M. Nowak, Henry Ford HealthFollow
Alexandre Mebazaa
Said Laribi
Judd E. Hollander
Mihai Gheorghiade
Sean P. Collins

Recommended Citation

Pang PS, Lane KA, Tavares M, Storrow AB, Shen C, Peacock WF, Nowak R, Mebazaa A, Laribi S, Hollander JE, Gheorghiade M, and Collins SP. Is there a clinically meaningful difference in patient reported dyspnea in acute heart failure? An analysis from URGENT Dyspnea. Heart Lung 2017.

Document Type

Article

Publication Date

7-1-2017

Publication Title

Heart & lung : the journal of critical care

Abstract

BACKGROUND: Dyspnea is the most common presenting symptom in patients with acute heart failure (AHF), but is difficult to quantify as a research measure. The URGENT Dyspnea study compared 3 scales: (1) 10 cm VAS, (2) 5-point Likert, and (3) a 7-point Likert (both VAS and 5-point Likert were recorded in the upright and supine positions). However, the minimal clinically important difference (MCID) to patients has not been well established.

METHODS: We performed a secondary analysis from URGENT Dyspnea, an observational, multi-center study of AHF patients enrolled within 1 h of first physician assessment in the ED. Using the anchor-based method to determine the MCID, a one-category change in the 7-point Likert was used as the criterion standard ('minimally improved or worse'). The main outcome measures were the change in visual analog scale (VAS) and 5-point Likert scale from baseline to 6-h assessment relative to a 1-category change response in the 7-point Likert scale ('minimally worse', 'no change', or 'minimally better').

RESULTS: Of the 776 patients enrolled, 491 had a final diagnosis of AHF with responses at both time points. A 10.5 mm (SD 1.6 mm) change in VAS was the MCID for improvement in the upright position, and 14.5 mm (SD 2.0 mm) in the supine position. However, there was no MCID for worsening, as few patients reported worse dyspnea. There was also no significant MCID for the 5-point Likert scale.

CONCLUSION: A 10.5 mm change is the MCID for improvement in dyspnea over 6 h in ED patients with AHF.

Medical Subject Headings

Acute Disease; Aged; Dyspnea; Emergency Service, Hospital; Female; Heart Failure; Humans; Male; Middle Aged; Prognosis; Severity of Illness Index

PubMed ID

28433323

Volume

46

Issue

4

First Page

300

Last Page

307