title: Measurement of Dyspnea in Ambulatory African Americans With Heart Failure and a Preserved or Reduced Ejection Fraction.
abstract: BACKGROUND
  Dyspnea is a burdensome and disabling heart failure (HF) symptom. Few studies examining dyspnea in HF have included African Americans (AAs), despite their developing HF at a younger age and having the highest mortality rates.
  
  
  OBJECTIVE
  The purpose of this cross-sectional study was to examine dyspnea in AA patients with HF and a preserved ejection fraction (HFpEF) compared with those with a reduced ejection fraction (HFrEF), before and after the 6-minute walk test (6MWT).
  
  
  METHODS
  A convenience sample of ambulatory AA patients (HFrEF, n = 26; HFpEF, n = 19) 50 years or older was recruited from an urban HF clinic. The Borg Scale and a visual analog scale (VAS) were used to measure dyspnea intensity before and after the 6MWT. Activity limitations related to dyspnea were described using the modified Medical Research Council Dyspnea Scale. Group comparisons were analyzed using repeated-measures analysis of variance and χ 2tests. Convergent validity was determined between the Borg and VAS using Bland-Altman plots.
  
  
  RESULTS
  No significant differences were found in age, gender, and comorbidities between HF groups. Most HFpEF patients reported dyspnea at baseline (Borg, 63%; VAS, 73%) and after the 6MWT (Borg, 78%; VAS, 79%). In the HFrEF group, the prevalence of baseline dyspnea was greater when measured with the VAS (Borg, 34%; VAS, 80%) but was similar between instruments after the 6MWT (Borg, 64%; VAS, 77%). Both groups reported a similar change in dyspnea intensity during and after the 6MWT. The Bland-Altman plots indicated moderate agreement at each time point. Most patients described walking hurriedly or uphill as dyspnea-provoking on the Modified Respiratory Council Dyspnea Scale.
  
  
  CONCLUSIONS
  The prevalence of dyspnea at baseline and after the 6MWT was high for both groups, but intensity varied with the dyspnea instrument used.
authors.affiliation: Karen M. Vuckovic, PhD, RN, ACNS Assistant Clinical Professor, College of Nursing, Department of Biobehavioral Health Science, University of Illinois at Chicago. Holli A. DeVon, PhD, RN Associate Professor, College of Nursing, Department of Biobehavioral Health Science, University of Illinois at Chicago. Mariann R. Piano, PhD, RN Professor, College of Nursing, Department of Biobehavioral Health Science, University of Illinois at Chicago.
authors.forename: Karen M
authors.initials: KM
authors.lastname: Vuckovic
authors.forename: Holli A
authors.initials: HA
authors.lastname: DeVon
authors.forename: Mariann R
authors.initials: MR
authors.lastname: Piano
mesh_terms: D001741:Black or African American; D000368:Aged; D003430:Cross-Sectional Studies; D004417:Dyspnea / Q000175:diagnosis / Q000208:ethnology*; D005080:Exercise Test; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000208:ethnology* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D013318:Stroke Volume / Q000502:physiology; D016138:Walking / Q000502:physiology*