TY - JOUR
T1 - Implications of Perceived Dyspnea and Global Well-Being Measured by Visual Assessment Scales During Treatment for Acute Decompensated Heart Failure
AU - Hendren, Nicholas S.
AU - Drazner, Mark H.
AU - Pandey, Ambarish
AU - Tang, W. H.Wilson
AU - Grodin, Justin L.
N1 - Funding Information:
This manuscript was prepared using research materials obtained from the National Institutes of Heart, Lung, and Blood Institute's (NHLBI) Biologic Specimen and Data Repository Information Coordinating Center (BioLINCC) via an approved proposal and does not necessarily reflects the opinions and views of the study investigators or the NHLBI.
Funding Information:
Drs. Grodin and Pandey received research funding from the Texas Health Resources Clinical Scholarship.
Publisher Copyright:
© 2019 Elsevier Inc.
PY - 2019/8/1
Y1 - 2019/8/1
N2 - Symptomatic improvement through decongestive therapy is a cornerstone for treatment of acute decompensated heart failure (ADHF). Visual analog scales (VAS) are instruments that can capture patients' perceptions of dyspnea (DVAS) or global well-being (GVAS). However, the clinical implications of these instruments and their changes over time during treatment for ADHF need further clarification. DVAS and GVAS were collected in 657 patients randomized in the DOSE-AHF and ROSE-AHF trials. To determine factors associated with symptom change, multivariable predictors of changes in DVAS and GVAS over 72 hours were determined. In addition, time-to-event analyses determined the association between these assessments and post-discharge clinical outcomes. The median baseline DVAS and GVAS scores were 54 (interquartile range 35 to 76) and 50 (30 to 66), respectively. These scores increased from baseline to 72 hours (ΔDVAS 16 [0 to 35] and ΔGVAS 19 [2 to 37]). Although changes in both scales were associated with their baseline values, 72-hour change in NT-proBNP was associated with each scale in multivariable analysis. However, there were additional variables associated with 72-hour change in GVAS including 72-hour change in creatinine, implantable cardioverter-defibrillator presence, baseline loop diuretic dose, and 72-hour total loop diuretic dose. There were no consistent associations between DVAS or GVAS and clinical composite outcomes at 60 days. In conclusion, DVAS and GVAS may be related to different clinical factors during treatment for ADHF and VAS scores were not consistently associated with clinical outcomes in ADHF. These findings inform the utility of the DVAS and GVAS instruments as measurements of symptom change for future ADHF clinical trials and registries.
AB - Symptomatic improvement through decongestive therapy is a cornerstone for treatment of acute decompensated heart failure (ADHF). Visual analog scales (VAS) are instruments that can capture patients' perceptions of dyspnea (DVAS) or global well-being (GVAS). However, the clinical implications of these instruments and their changes over time during treatment for ADHF need further clarification. DVAS and GVAS were collected in 657 patients randomized in the DOSE-AHF and ROSE-AHF trials. To determine factors associated with symptom change, multivariable predictors of changes in DVAS and GVAS over 72 hours were determined. In addition, time-to-event analyses determined the association between these assessments and post-discharge clinical outcomes. The median baseline DVAS and GVAS scores were 54 (interquartile range 35 to 76) and 50 (30 to 66), respectively. These scores increased from baseline to 72 hours (ΔDVAS 16 [0 to 35] and ΔGVAS 19 [2 to 37]). Although changes in both scales were associated with their baseline values, 72-hour change in NT-proBNP was associated with each scale in multivariable analysis. However, there were additional variables associated with 72-hour change in GVAS including 72-hour change in creatinine, implantable cardioverter-defibrillator presence, baseline loop diuretic dose, and 72-hour total loop diuretic dose. There were no consistent associations between DVAS or GVAS and clinical composite outcomes at 60 days. In conclusion, DVAS and GVAS may be related to different clinical factors during treatment for ADHF and VAS scores were not consistently associated with clinical outcomes in ADHF. These findings inform the utility of the DVAS and GVAS instruments as measurements of symptom change for future ADHF clinical trials and registries.
UR - http://www.scopus.com/inward/record.url?scp=85065869569&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85065869569&partnerID=8YFLogxK
U2 - 10.1016/j.amjcard.2019.05.011
DO - 10.1016/j.amjcard.2019.05.011
M3 - Article
C2 - 31128735
AN - SCOPUS:85065869569
SN - 0002-9149
VL - 124
SP - 402
EP - 408
JO - American Journal of Cardiology
JF - American Journal of Cardiology
IS - 3
ER -