title: Predictors of early dyspnoea relief in acute heart failure and the association with 30-day outcomes: findings from ASCEND-HF.
abstract: OBJECTIVE
  To examine the characteristics associated with early dyspnoea relief during acute heart failure (HF) hospitalization, and its association with 30-day outcomes.
  
  
  RESULTS
  ASCEND-HF was a randomized trial of nesiritide vs. placebo in 7141 patients hospitalized with acute HF in which dyspnoea relief at 6 h was measured on a 7-point Likert scale. Patients were classified as having early dyspnoea relief if they experienced moderate or marked dyspnoea improvement at 6 h. We analysed the clinical characteristics, geographical variation, and outcomes (mortality, mortality/HF hospitalization, and mortality/hospitalization at 30 days) associated with early dyspnoea relief. Early dyspnoea relief occurred in 2984 patients (43%). In multivariable analyses, predictors of dyspnoea relief included older age and oedema on chest radiograph; higher systolic blood pressure, respiratory rate, and natriuretic peptide level; and lower serum blood urea nitrogen (BUN), sodium, and haemoglobin (model mean C index = 0.590). Dyspnoea relief varied markedly across countries, with patients enrolled from Central Europe having the lowest risk-adjusted likelihood of improvement. Early dyspnoea relief was associated with lower risk-adjusted 30-day mortality/HF hospitalization [hazard ratio (HR) 0.81; 95% confidence interval (CI) 0.68-0.96] and mortality/hospitalization (HR 0.85; 95% CI 0.74-0.99), but similar mortality.
  
  
  CONCLUSIONS
  Clinical characteristics such as respiratory rate, pulmonary oedema, renal function, and natriuretic peptide levels are associated with early dyspnoea relief, and moderate or marked improvement in dyspnoea was associated with a lower risk for 30-day outcomes.
authors.affiliation: Duke University Medical Center, Durham, NC, USA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Mentz
authors.forename: Adrian F
authors.initials: AF
authors.lastname: Hernandez
authors.forename: Amanda
authors.initials: A
authors.lastname: Stebbins
authors.forename: Justin A
authors.initials: JA
authors.lastname: Ezekowitz
authors.forename: G Michael
authors.initials: GM
authors.lastname: Felker
authors.forename: Gretchen M
authors.initials: GM
authors.lastname: Heizer
authors.forename: Dan
authors.initials: D
authors.lastname: Atar
authors.forename: John R
authors.initials: JR
authors.lastname: Teerlink
authors.forename: Robert M
authors.initials: RM
authors.lastname: Califf
authors.forename: Barry M
authors.initials: BM
authors.lastname: Massie
authors.forename: Vic
authors.initials: V
authors.lastname: Hasselblad
authors.forename: Randall C
authors.initials: RC
authors.lastname: Starling
authors.forename: Christopher M
authors.initials: CM
authors.lastname: O'Connor
authors.forename: Piotr
authors.initials: P
authors.lastname: Ponikowski
mesh_terms: D000208:Acute Disease; D000367:Age Factors; D000368:Aged; D001794:Blood Pressure; D001806:Blood Urea Nitrogen; D004417:Dyspnea / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D004487:Edema; D005260:Female; D006333:Heart Failure / Q000503:physiopathology*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D045283:Natriuretic Agents / Q000627:therapeutic use*; D020097:Natriuretic Peptide, Brain / Q000627:therapeutic use*; D045265:Natriuretic Peptides / Q000097:blood; D056152:Respiratory Rate; D018570:Risk Assessment; D016896:Treatment Outcome
chemical_list: D045283:Natriuretic Agents; D045265:Natriuretic Peptides; D020097:Natriuretic Peptide, Brain