Dyspnoea and worsening heart failure in patients with acute heart failure: results from the Pre-RELAX-AHF study.
OBJECTIVE
Although dyspnoea is the most common cause of admission for acute heart failure (AHF), more needs to be known about its clinical course and prognostic significance.


RESULTS
The Pre-RELAX-AHF study randomized 232 subjects with AHF to placebo or four doses of relaxin and evaluated early (6-24 h Likert scale) and persistent [change in visual analogue scale area under the curve (VAS AUC) through Day 5] dyspnoea relief. Worsening heart failure (WHF) was defined as worsening AHF signs and symptoms requiring additional therapy. Patients were followed until Day 180. Early dyspnoea relief was observed in only 25% of all patients, and VAS AUC at 5 days was 45% over baseline values in all patients (32% placebo; 50% all relaxin-treated patients). Worsening heart failure to Day 5 was observed in 16% of all patients (21% placebo; 14% relaxin). Lack of persistent dyspnoea relief and WHF were associated with a longer length of initial hospital stay and worse 60-day outcomes.


CONCLUSIONS
Dyspnoea relief in patients admitted with AHF is often incomplete, and many may show WHF after the initial stabilization. Both lack of persistent dyspnoea relief and in-hospital WHF predict a longer length of stay and worse outcome.
Metra
Marco
M
Cardiology, Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy. metramarco@libero.it
Teerlink
John R
JR
Felker
G Michael
GM
Greenberg
Barry H
BH
Filippatos
Gerasimos
G
Ponikowski
Piotr
P
Teichman
Sam L
SL
Unemori
Elaine
E
Voors
Adriaan A
AA
Weatherley
Beth Davison
BD
Cotter
Gad
G
D000368:Aged; D019540:Area Under Curve; D018450:Disease Progression; D004417:Dyspnea / Q000209:etiology*; D005260:Female; D006305:Health Status Indicators; D006333:Heart Failure / Q000150:complications*; D006760:Hospitalization; D006801:Humans; D053208:Kaplan-Meier Estimate; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D010147:Pain Measurement; D011379:Prognosis; D013223:Statistics as Topic