Evaluation of a provocative dyspnea severity score in acute heart failure

Omar F. AbouEzzeddine, Anuradha Lala, Prateeti P. Khazanie, Ravi Shah, Jennifer E. Ho, Horng H. Chen, Peter Pang, Steven E. McNulty, Kevin J. Anstrom, Adrian F. Hernandez, Margaret M. Redfield

Research output: Contribution to journalArticle

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Abstract

Background The acute heart failure (AHF) Syndromes International Working Group proposed that dyspnea be assessed under standardized, incrementally provocative maneuvers and called for studies to assess the feasibility of this approach. We sought to assess the feasibility and statistical characteristics of a novel provocative dyspnea severity score (pDS) versus the traditional dyspnea visual analog scale (DVAS) in an AHF trial. Methods At enrollment, 24, 48 and 72 hours, 230 ROSE-AHF patients completed a DVAS. Dyspnea was then assessed with 5-point Likert dyspnea scales administered during 4 stages (A: upright-with O2, B: upright-without O2, C: supine-without O2 and D: exercise-without O2). Patients with moderate or less dyspnea were eligible for the next stage. Results At enrollment, oxygen withdrawal and supine provocation were highly feasible (≥97%), provoking more severe dyspnea (≥1 Likert point) in 24% and 42% of eligible patients, respectively. Exercise provocation had low feasibility with 38% of eligible patients unable to exercise due to factors other than dyspnea. A pDS was constructed from Likert scales during the 3 feasible assessment conditions (A-C). Relative to DVAS, the distribution of the pDS was more skewed with a high "ceiling effect" at enrollment (23%) limiting sensitivity to change. Change in pDS was not related to decongestion or 60-day outcomes. Conclusions Although oxygen withdrawal and supine provocation are feasible and elicit more severe dyspnea, exercise provocation had unacceptable feasibility in this AHF cohort. The statistical characteristics of a pDS based on feasible provocation measures do not support its potential as a robust dyspnea assessment tool in AHF.

Original languageEnglish (US)
Pages (from-to)34-41
Number of pages8
JournalAmerican Heart Journal
Volume172
DOIs
StatePublished - Feb 1 2016

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Dyspnea
Heart Failure
Visual Analog Scale
Exercise
Oxygen

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

AbouEzzeddine, O. F., Lala, A., Khazanie, P. P., Shah, R., Ho, J. E., Chen, H. H., ... Redfield, M. M. (2016). Evaluation of a provocative dyspnea severity score in acute heart failure. American Heart Journal, 172, 34-41. https://doi.org/10.1016/j.ahj.2015.10.009

Evaluation of a provocative dyspnea severity score in acute heart failure. / AbouEzzeddine, Omar F.; Lala, Anuradha; Khazanie, Prateeti P.; Shah, Ravi; Ho, Jennifer E.; Chen, Horng H.; Pang, Peter; McNulty, Steven E.; Anstrom, Kevin J.; Hernandez, Adrian F.; Redfield, Margaret M.

In: American Heart Journal, Vol. 172, 01.02.2016, p. 34-41.

Research output: Contribution to journalArticle

AbouEzzeddine, OF, Lala, A, Khazanie, PP, Shah, R, Ho, JE, Chen, HH, Pang, P, McNulty, SE, Anstrom, KJ, Hernandez, AF & Redfield, MM 2016, 'Evaluation of a provocative dyspnea severity score in acute heart failure', American Heart Journal, vol. 172, pp. 34-41. https://doi.org/10.1016/j.ahj.2015.10.009
AbouEzzeddine OF, Lala A, Khazanie PP, Shah R, Ho JE, Chen HH et al. Evaluation of a provocative dyspnea severity score in acute heart failure. American Heart Journal. 2016 Feb 1;172:34-41. https://doi.org/10.1016/j.ahj.2015.10.009
AbouEzzeddine, Omar F. ; Lala, Anuradha ; Khazanie, Prateeti P. ; Shah, Ravi ; Ho, Jennifer E. ; Chen, Horng H. ; Pang, Peter ; McNulty, Steven E. ; Anstrom, Kevin J. ; Hernandez, Adrian F. ; Redfield, Margaret M. / Evaluation of a provocative dyspnea severity score in acute heart failure. In: American Heart Journal. 2016 ; Vol. 172. pp. 34-41.
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abstract = "Background The acute heart failure (AHF) Syndromes International Working Group proposed that dyspnea be assessed under standardized, incrementally provocative maneuvers and called for studies to assess the feasibility of this approach. We sought to assess the feasibility and statistical characteristics of a novel provocative dyspnea severity score (pDS) versus the traditional dyspnea visual analog scale (DVAS) in an AHF trial. Methods At enrollment, 24, 48 and 72 hours, 230 ROSE-AHF patients completed a DVAS. Dyspnea was then assessed with 5-point Likert dyspnea scales administered during 4 stages (A: upright-with O2, B: upright-without O2, C: supine-without O2 and D: exercise-without O2). Patients with moderate or less dyspnea were eligible for the next stage. Results At enrollment, oxygen withdrawal and supine provocation were highly feasible (≥97{\%}), provoking more severe dyspnea (≥1 Likert point) in 24{\%} and 42{\%} of eligible patients, respectively. Exercise provocation had low feasibility with 38{\%} of eligible patients unable to exercise due to factors other than dyspnea. A pDS was constructed from Likert scales during the 3 feasible assessment conditions (A-C). Relative to DVAS, the distribution of the pDS was more skewed with a high {"}ceiling effect{"} at enrollment (23{\%}) limiting sensitivity to change. Change in pDS was not related to decongestion or 60-day outcomes. Conclusions Although oxygen withdrawal and supine provocation are feasible and elicit more severe dyspnea, exercise provocation had unacceptable feasibility in this AHF cohort. The statistical characteristics of a pDS based on feasible provocation measures do not support its potential as a robust dyspnea assessment tool in AHF.",
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AU - AbouEzzeddine, Omar F.

AU - Lala, Anuradha

AU - Khazanie, Prateeti P.

AU - Shah, Ravi

AU - Ho, Jennifer E.

AU - Chen, Horng H.

AU - Pang, Peter

AU - McNulty, Steven E.

AU - Anstrom, Kevin J.

AU - Hernandez, Adrian F.

AU - Redfield, Margaret M.

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N2 - Background The acute heart failure (AHF) Syndromes International Working Group proposed that dyspnea be assessed under standardized, incrementally provocative maneuvers and called for studies to assess the feasibility of this approach. We sought to assess the feasibility and statistical characteristics of a novel provocative dyspnea severity score (pDS) versus the traditional dyspnea visual analog scale (DVAS) in an AHF trial. Methods At enrollment, 24, 48 and 72 hours, 230 ROSE-AHF patients completed a DVAS. Dyspnea was then assessed with 5-point Likert dyspnea scales administered during 4 stages (A: upright-with O2, B: upright-without O2, C: supine-without O2 and D: exercise-without O2). Patients with moderate or less dyspnea were eligible for the next stage. Results At enrollment, oxygen withdrawal and supine provocation were highly feasible (≥97%), provoking more severe dyspnea (≥1 Likert point) in 24% and 42% of eligible patients, respectively. Exercise provocation had low feasibility with 38% of eligible patients unable to exercise due to factors other than dyspnea. A pDS was constructed from Likert scales during the 3 feasible assessment conditions (A-C). Relative to DVAS, the distribution of the pDS was more skewed with a high "ceiling effect" at enrollment (23%) limiting sensitivity to change. Change in pDS was not related to decongestion or 60-day outcomes. Conclusions Although oxygen withdrawal and supine provocation are feasible and elicit more severe dyspnea, exercise provocation had unacceptable feasibility in this AHF cohort. The statistical characteristics of a pDS based on feasible provocation measures do not support its potential as a robust dyspnea assessment tool in AHF.

AB - Background The acute heart failure (AHF) Syndromes International Working Group proposed that dyspnea be assessed under standardized, incrementally provocative maneuvers and called for studies to assess the feasibility of this approach. We sought to assess the feasibility and statistical characteristics of a novel provocative dyspnea severity score (pDS) versus the traditional dyspnea visual analog scale (DVAS) in an AHF trial. Methods At enrollment, 24, 48 and 72 hours, 230 ROSE-AHF patients completed a DVAS. Dyspnea was then assessed with 5-point Likert dyspnea scales administered during 4 stages (A: upright-with O2, B: upright-without O2, C: supine-without O2 and D: exercise-without O2). Patients with moderate or less dyspnea were eligible for the next stage. Results At enrollment, oxygen withdrawal and supine provocation were highly feasible (≥97%), provoking more severe dyspnea (≥1 Likert point) in 24% and 42% of eligible patients, respectively. Exercise provocation had low feasibility with 38% of eligible patients unable to exercise due to factors other than dyspnea. A pDS was constructed from Likert scales during the 3 feasible assessment conditions (A-C). Relative to DVAS, the distribution of the pDS was more skewed with a high "ceiling effect" at enrollment (23%) limiting sensitivity to change. Change in pDS was not related to decongestion or 60-day outcomes. Conclusions Although oxygen withdrawal and supine provocation are feasible and elicit more severe dyspnea, exercise provocation had unacceptable feasibility in this AHF cohort. The statistical characteristics of a pDS based on feasible provocation measures do not support its potential as a robust dyspnea assessment tool in AHF.

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