Dyspnoea in patients with acute heart failure: an analysis of its clinical course, determinants, and relationship to 60-day outcomes in the PROTECT pilot study.
OBJECTIVE
Dyspnoea is the most common symptom leading to hospitalization for acute heart failure (AHF). Its early and persistent relief is an important goal of therapy, but little is known about its course, determinants, and prognostic significance.


RESULTS
In a post hoc analysis, we studied changes in dyspnoea and in-hospital course in 303 subjects with AHF enrolled in the PROTECT pilot trial. Changes in dyspnoea were assessed by patient self-report using a seven-point Likert scale daily to discharge and at Days 7 and 14. We defined dyspnoea relief as a moderate to marked improvement of dyspnoea at both 24 and 48 h, and treatment success as dyspnoea relief without worsening HF or renal function or death during the first 7 days. Dyspnoea relief occurred in 54% of the patients, while treatment success was achieved in 44% of the patients. By Day 14, only 75% of patients reported a moderate or marked improvement in dyspnoea. Both dyspnoea relief and treatment success were associated with greater improvement in signs of congestion, shorter hospitalization duration, and a lower 60-day mortality rate. Treatment success, but not dyspnoea relief, was also associated with a lower incidence of 60-day death or re-hospitalization for HF or renal failure.


CONCLUSIONS
Half of patients admitted for AHF do not have substantial improvement in dyspnoea at 24 h and 25% do not have substantial improvement at 7 and 14 days from admission. Dyspnoea relief and treatment success are associated with shorter length of stay and lower 60-day mortality. These analyses should be confirmed in larger studies.
Cardiology, University of Brescia, P.zza Spedali Civili, Brescia 25100, Italy. metramarco@libero.it
Marco
M
Metra
John G
JG
Cleland
Beth Davison
BD
Weatherley
Howard C
HC
Dittrich
Michael M
MM
Givertz
Barry M
BM
Massie
Christopher M
CM
O'Connor
Piotr
P
Ponikowski
John R
JR
Teerlink
Adriaan A
AA
Voors
Gad
G
Cotter
D000368:Aged; D004232:Diuretics / Q000627:therapeutic use; D004417:Dyspnea / Q000188:drug therapy / Q000209:etiology*; D005060:Europe; D005260:Female; D006305:Health Status Indicators; D006333:Heart Failure / Q000150:complications* / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology; D006760:Hospitalization; D006801:Humans; D007558:Italy; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D016896:Treatment Outcome; D014970:Xanthines / Q000627:therapeutic use
D004232:Diuretics; D014970:Xanthines; C073525:rolofylline