Dyspnoea in Patients With Acute Heart Failure
Dyspnoea in Patients With Acute Heart Failure
Aims Dyspnoea is the most common symptom leading to hospitalization for acute heart failure (AHF). Its early and persistent relief is an important goal of therapy, but little is known about its course, determinants, and prognostic significance.
Methods and results In a post hoc analysis, we studied changes in dyspnoea and in-hospital course in 303 subjects with AHF enrolled in the PROTECT pilot trial. Changes in dyspnoea were assessed by patient self-report using a seven-point Likert scale daily to discharge and at Days 7 and 14. We defined dyspnoea relief as a moderate to marked improvement of dyspnoea at both 24 and 48 h, and treatment success as dyspnoea relief without worsening HF or renal function or death during the first 7 days. Dyspnoea relief occurred in 54% of the patients, while treatment success was achieved in 44% of the patients. By Day 14, only 75% of patients reported a moderate or marked improvement in dyspnoea. Both dyspnoea relief and treatment success were associated with greater improvement in signs of congestion, shorter hospitalization duration, and a lower 60-day mortality rate. Treatment success, but not dyspnoea relief, was also associated with a lower incidence of 60-day death or re-hospitalization for HF or renal failure.
Conclusion Half of patients admitted for AHF do not have substantial improvement in dyspnoea at 24 h and 25% do not have substantial improvement at 7 and 14 days from admission. Dyspnoea relief and treatment success are associated with shorter length of stay and lower 60-day mortality. These analyses should be confirmed in larger studies.
Acute heart failure (AHF) remains a common reason for hospitalization in people aged >65 years in all but the poorest countries. Its treatment has changed little in the last few decades and remains unsatisfactory with respect to both symptom relief and patient outcomes.
Dyspnoea is the principal reason for hospitalization for patients with AHF and is often associated with signs of fluid overload, including pulmonary and/or peripheral congestion. Recent AHF studies have shown that many patients have only partial relief of dyspnoea and congestion during admission. Furthermore, depending on the definition, 20–40% of patients may develop recurrent symptoms and signs of HF (worsening HF, WHF) and/or of worsening renal function (WRF) during the hospitalization. These disappointing results are observed even when guideline-recommended therapies are fully implemented. Moreover, new agents for the treatment of AHF have not shown convincing benefits. Hence, rapid and persistent improvement of dyspnoea and congestion with no untoward effects on outcomes remain important and unmet goals of AHF therapy.
Relief of dyspnoea, death, or WHF during hospitalization and WRF were prospectively defined and assessed in the PROTECT pilot trial, a study assessing the efficacy and safety of the new adenosine type A1 receptor antagonist, rolofylline, in patients hospitalized with AHF, mild to moderate renal dysfunction, signs of fluid overload, and increased plasma concentrations of BNP or NT-proBNP. In the present post hoc analysis, we assessed the factors associated with relief of dyspnoea and with treatment success (a combined endpoint combining relief of dyspnoea with the absence of death or WHF or WRF during the hospitalization), and their relationship to changes in the other symptoms and signs and to 60-day outcomes, in the patients enrolled in the PROTECT pilot trial.
Abstract and Introduction
Abstract
Aims Dyspnoea is the most common symptom leading to hospitalization for acute heart failure (AHF). Its early and persistent relief is an important goal of therapy, but little is known about its course, determinants, and prognostic significance.
Methods and results In a post hoc analysis, we studied changes in dyspnoea and in-hospital course in 303 subjects with AHF enrolled in the PROTECT pilot trial. Changes in dyspnoea were assessed by patient self-report using a seven-point Likert scale daily to discharge and at Days 7 and 14. We defined dyspnoea relief as a moderate to marked improvement of dyspnoea at both 24 and 48 h, and treatment success as dyspnoea relief without worsening HF or renal function or death during the first 7 days. Dyspnoea relief occurred in 54% of the patients, while treatment success was achieved in 44% of the patients. By Day 14, only 75% of patients reported a moderate or marked improvement in dyspnoea. Both dyspnoea relief and treatment success were associated with greater improvement in signs of congestion, shorter hospitalization duration, and a lower 60-day mortality rate. Treatment success, but not dyspnoea relief, was also associated with a lower incidence of 60-day death or re-hospitalization for HF or renal failure.
Conclusion Half of patients admitted for AHF do not have substantial improvement in dyspnoea at 24 h and 25% do not have substantial improvement at 7 and 14 days from admission. Dyspnoea relief and treatment success are associated with shorter length of stay and lower 60-day mortality. These analyses should be confirmed in larger studies.
Introduction
Acute heart failure (AHF) remains a common reason for hospitalization in people aged >65 years in all but the poorest countries. Its treatment has changed little in the last few decades and remains unsatisfactory with respect to both symptom relief and patient outcomes.
Dyspnoea is the principal reason for hospitalization for patients with AHF and is often associated with signs of fluid overload, including pulmonary and/or peripheral congestion. Recent AHF studies have shown that many patients have only partial relief of dyspnoea and congestion during admission. Furthermore, depending on the definition, 20–40% of patients may develop recurrent symptoms and signs of HF (worsening HF, WHF) and/or of worsening renal function (WRF) during the hospitalization. These disappointing results are observed even when guideline-recommended therapies are fully implemented. Moreover, new agents for the treatment of AHF have not shown convincing benefits. Hence, rapid and persistent improvement of dyspnoea and congestion with no untoward effects on outcomes remain important and unmet goals of AHF therapy.
Relief of dyspnoea, death, or WHF during hospitalization and WRF were prospectively defined and assessed in the PROTECT pilot trial, a study assessing the efficacy and safety of the new adenosine type A1 receptor antagonist, rolofylline, in patients hospitalized with AHF, mild to moderate renal dysfunction, signs of fluid overload, and increased plasma concentrations of BNP or NT-proBNP. In the present post hoc analysis, we assessed the factors associated with relief of dyspnoea and with treatment success (a combined endpoint combining relief of dyspnoea with the absence of death or WHF or WRF during the hospitalization), and their relationship to changes in the other symptoms and signs and to 60-day outcomes, in the patients enrolled in the PROTECT pilot trial.
