TY - JOUR
T1 - Evaluation of Novel Metrics of Symptom Relief in Acute Heart Failure
T2 - The Worst Symptom Score
AU - AbouEzzeddine, Omar F.
AU - Wong, Yee Weng
AU - Mentz, Robert J.
AU - Raza, Sadi S.
AU - Nativi-Nicolau, Jose
AU - Kociol, Robb D.
AU - McNulty, Steven E.
AU - Anstrom, Kevin J.
AU - Hernandez, Adrian F.
AU - Redfield, Margaret M.
N1 - Publisher Copyright:
© 2015 Elsevier Inc.
PY - 2016/11/1
Y1 - 2016/11/1
N2 - 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.
AB - 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.
KW - Acute heart failure
KW - clinical trials
KW - quality of life
UR - http://www.scopus.com/inward/record.url?scp=84993881912&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84993881912&partnerID=8YFLogxK
U2 - 10.1016/j.cardfail.2015.12.015
DO - 10.1016/j.cardfail.2015.12.015
M3 - Article
C2 - 26718344
AN - SCOPUS:84993881912
SN - 1071-9164
VL - 22
SP - 853
EP - 858
JO - Journal of Cardiac Failure
JF - Journal of Cardiac Failure
IS - 11
ER -