title: Improvements in signs and symptoms during hospitalization for acute heart failure follow different patterns and depend on the measurement scales used: an international, prospective registry to evaluate the evolution of measures of disease severity in acute heart failure (MEASURE-AHF).
abstract: BACKGROUND
  The natural evolution of signs and symptoms during acute heart failure (AHF) is poorly characterized.
  
  
  RESULTS
  We followed a prospective international cohort of 182 patients hospitalized with AHF. Patient-reported dyspnea and general well-being (GWB) were measured daily using 7-tier Likert (-3 to +3) and visual analog scales (VAS, 0-100). Physician assessments were also recorded daily. Mean age was 69 years and 68% had ejection fraction <40%. Likert measures of dyspnea initially improved rapidly (day 1, 0.22; day 2, 1.31; P <.001) with no significant improvement thereafter (day 7, 1.51; day 2 versus 7 P = .16). In contrast, VAS measure of dyspnea improved throughout hospitalization (day 1, 50.1; day 2, 64.7; day 7, 83.2; day 1 versus 2 P < .001, day 2 versus 7 P < .001). Symptoms of dyspnea and GWB tracked closely (correlation r = .813, P < .001). Physical signs resolved more completely than did symptoms (eg, from day 1 to discharge/day 7, absence of edema increased from 33% to 72% of patients, whereas significant improvements in dyspnea increased from 27% to 52% of patients; P < .001).
  
  
  CONCLUSIONS
  Changes in patient-reported symptoms and physician-assessed signs followed different patterns during an AHF episode and are influenced by the measurement scales used. Multiple clinical measures should be considered in discharge decisions and evaluation of AHF therapies.
authors.affiliation: Division of Cardiology, University of Colorado Denver, Aurora, CO 80045, USA. larry_allen@post.harvard.edu
authors.forename: Larry A
authors.initials: LA
authors.lastname: Allen
authors.forename: Marco
authors.initials: M
authors.lastname: Metra
authors.forename: Olga
authors.initials: O
authors.lastname: Milo-Cotter
authors.forename: Gerasimos
authors.initials: G
authors.lastname: Filippatos
authors.forename: Leonardo H
authors.initials: LH
authors.lastname: Reisin
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Bensimhon
authors.forename: Edoardo G
authors.initials: EG
authors.lastname: Gronda
authors.forename: Paolo
authors.initials: P
authors.lastname: Colombo
authors.forename: G Michael
authors.initials: GM
authors.lastname: Felker
authors.forename: Livio Dei
authors.initials: LD
authors.lastname: Cas
authors.forename: Dimitrios T
authors.initials: DT
authors.lastname: Kremastinos
authors.forename: Christopher M
authors.initials: CM
authors.lastname: O'Connor
authors.forename: Gadi
authors.initials: G
authors.lastname: Cotter
authors.forename: Beth A
authors.initials: BA
authors.lastname: Davison
authors.forename: Howard C
authors.initials: HC
authors.lastname: Dittrich
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Velazquez
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D038622:Internationality; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000592:standards / Q000639:trends*; D010351:Patient Discharge / Q000592:standards / Q000639:trends*; D011446:Prospective Studies; D012042:Registries / Q000592:standards*; D012720:Severity of Illness Index; D014894:Weights and Measures / Q000592:standards*