title: The impact of early standard therapy on dyspnoea in patients with acute heart failure: the URGENT-dyspnoea study.
abstract: 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.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, INSERM U942, University Paris Diderot, Paris, France.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Mebazaa
authors.forename: Peter S
authors.initials: PS
authors.lastname: Pang
authors.forename: Miguel
authors.initials: M
authors.lastname: Tavares
authors.forename: Sean P
authors.initials: SP
authors.lastname: Collins
authors.forename: Alan B
authors.initials: AB
authors.lastname: Storrow
authors.forename: Said
authors.initials: S
authors.lastname: Laribi
authors.forename: Stephanie
authors.initials: S
authors.lastname: Andre
authors.forename: Daniel
authors.initials: D
authors.lastname: Mark Courtney
authors.forename: Jennifer
authors.initials: J
authors.lastname: Hasa
authors.forename: Jindrich
authors.initials: J
authors.lastname: Spinar
authors.forename: Josep
authors.initials: J
authors.lastname: Masip
authors.forename: William
authors.initials: W
authors.lastname: Frank Peacock
authors.forename: Karen
authors.initials: K
authors.lastname: Sliwa
authors.forename: Etienne
authors.initials: E
authors.lastname: Gayat
authors.forename: Gerasimos
authors.initials: G
authors.lastname: Filippatos
authors.forename: John G F
authors.initials: JG
authors.lastname: Cleland
authors.forename: Mihai
authors.initials: M
authors.lastname: Gheorghiade
mesh_terms: 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
chemical_list: D004232:Diuretics