The impact of early standard therapy on dyspnoea in patients with acute heart failure: the URGENT-dyspnoea study.
OBJECTIVE
The vast majority of acute heart failure (AHF) trials to date have targeted dyspnoea. However, they enrolled patients relatively late and did not standardize their methods of dyspnoea measurement. URGENT Dyspnoea was designed to determine changes in dyspnoea in response to initial, standard therapy in patients presenting with AHF using a standardized approach.


RESULTS
URGENT Dyspnoea was an international, multi-centre, observational cohort study of AHF patients managed conventionally and enrolled within 1 h of first hospital medical evaluation. Patient-assessed dyspnoea was recorded in the sitting position at baseline and at 6 hours by Likert and visual analog scales. Less symptomatic patients were placed supine to determine whether this provoked worsening dyspnoea (orthopnoea). Of the 524 patients with AHF, the mean age was 68 years, 43% were women, and 83% received intravenous diuretics. On a 5-point Likert scale, dyspnoea improvement was reported by 76% of patients after 6 h of standard therapy. Supine positioning (orthopnoea test) led to worse dyspnoea in 47% of patients compared to sitting upright.


CONCLUSIONS
When sitting upright, dyspnoea in the sitting position improves rapidly and substantially in patients with AHF after administration of conventional therapy, mainly intra-venous diuretics. However, many patients remain orthopnoeic. Improving the methodology of clinical trials in AHF by standardizing the conditions under which dyspnoea is assessed could enhance their ability to identify effective treatments. Relief of orthopnoea is clinically valuable and may represent a useful goal for clinical trials.
Mebazaa
Alexandre
A
Department of Anesthesiology and Critical Care Medicine, INSERM U942, University Paris Diderot, Paris, France.
Pang
Peter S
PS
Tavares
Miguel
M
Collins
Sean P
SP
Storrow
Alan B
AB
Laribi
Said
S
Andre
Stephanie
S
Mark Courtney
Daniel
D
Hasa
Jennifer
J
Spinar
Jindrich
J
Masip
Josep
J
Frank Peacock
William
W
Sliwa
Karen
K
Gayat
Etienne
E
Filippatos
Gerasimos
G
Cleland
John G F
JG
Gheorghiade
Mihai
M
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D004232:Diuretics / Q000627:therapeutic use; D004417:Dyspnea / Q000188:drug therapy* / Q000209:etiology; D004636:Emergency Service, Hospital; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000209:etiology; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D056888:Patient Positioning; D011187:Posture; D011446:Prospective Studies
D004232:Diuretics