Is there a clinically meaningful difference in patient reported dyspnea in acute heart failure? An analysis from URGENT Dyspnea

Peter S. Pang, Kathleen A. Lane, Miguel Tavares, Alan B. Storrow, Changyu Shen, W. Frank Peacock, Richard Nowak, Alexandre Mebazaa, Said Laribi, Judd E. Hollander, Mihai Gheorghiade, Sean P. Collins

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Abstract

Background Dyspnea is the most common presenting symptom in patients with acute heart failure (AHF), but is difficult to quantify as a research measure. The URGENT Dyspnea study compared 3 scales: (1) 10 cm VAS, (2) 5-point Likert, and (3) a 7-point Likert (both VAS and 5-point Likert were recorded in the upright and supine positions). However, the minimal clinically important difference (MCID) to patients has not been well established. Methods We performed a secondary analysis from URGENT Dyspnea, an observational, multi-center study of AHF patients enrolled within 1 h of first physician assessment in the ED. Using the anchor-based method to determine the MCID, a one-category change in the 7-point Likert was used as the criterion standard (‘minimally improved or worse’). The main outcome measures were the change in visual analog scale (VAS) and 5-point Likert scale from baseline to 6-h assessment relative to a 1-category change response in the 7-point Likert scale (‘minimally worse’, ‘no change’, or ‘minimally better’). Results Of the 776 patients enrolled, 491 had a final diagnosis of AHF with responses at both time points. A 10.5 mm (SD 1.6 mm) change in VAS was the MCID for improvement in the upright position, and 14.5 mm (SD 2.0 mm) in the supine position. However, there was no MCID for worsening, as few patients reported worse dyspnea. There was also no significant MCID for the 5-point Likert scale. Conclusion A 10.5 mm change is the MCID for improvement in dyspnea over 6 h in ED patients with AHF.

Original languageEnglish (US)
Pages (from-to)300-307
Number of pages8
JournalHeart and Lung: Journal of Acute and Critical Care
Volume46
Issue number4
DOIs
StatePublished - Jul 2017

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Keywords

  • Acute heart failure
  • Dyspnea
  • Emergency department
  • MCID
  • Shortness of breath

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Pang, P. S., Lane, K. A., Tavares, M., Storrow, A. B., Shen, C., Peacock, W. F., Nowak, R., Mebazaa, A., Laribi, S., Hollander, J. E., Gheorghiade, M., & Collins, S. P. (2017). Is there a clinically meaningful difference in patient reported dyspnea in acute heart failure? An analysis from URGENT Dyspnea. Heart and Lung: Journal of Acute and Critical Care, 46(4), 300-307. https://doi.org/10.1016/j.hrtlng.2017.03.003