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

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• 作者：Omar F. AbouEzzeddine ; MDCM¹ ; ^{abouezzeddine.omar@mayo.edu" class="auth_mail" title="E-mail the corresponding author} ; Yee Weng Wong ; MBBS² ; ³ ; Robert J. Mentz ; MD² ; ³ ; Sadi S. Raza ; MD⁴ ; Jose Nativi-Nicolau ; MD⁵ ; Robb D. Kociol ; MD⁶ ; Steven E. McNulty ; MS³ ; Kevin J. Anstrom ; PhD³ ; Adrian F. Hernandez ; MD ; MHS³ ; Margaret M. Redfield ; MD¹ ; for the NHLBI Heart Failure Clinical Research Network
• 关键词：Acute heart failure ; clinical trials ; quality of life
• 刊名：Journal of Cardiac Failure
• 出版年：2016
• 出版时间：November 2016
• 年：2016
• 卷：22
• 期：11
• 页码：853-858
• 全文大小：609 K

文摘

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.

d="absSec_2">Background

d="sp0015">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.

d="absSec_3">Methods and Results

d="sp0020">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&ndash;B-type natriuretic peptide, weight or cumulative 72-hour urine volume).

d="absSec_4">Conclusions

d="sp0025">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.