title: The Trajectory of Dyspnea in Hospitalized Patients.
abstract: BACKGROUND
  The trajectory of dyspnea for patients hospitalized with acute cardiopulmonary disease, who are not terminally ill, is poorly characterized.
  
  
  OBJECTIVE
  To investigate the natural history of dyspnea during hospitalization and examine the role that admission diagnosis, and patient factors play in altering symptom resolution.
  
  
  METHODS
  Prospective cohort study of patients hospitalized for an acute cardiopulmonary condition at a large tertiary care center. Dyspnea levels and change in dyspnea score were the main outcomes of interest and were assessed at admission, 24 and 48 hours, and at discharge using the verbal 0-10 numeric scale.
  
  
  RESULTS
  Among 295 patients enrolled, the median age was 68 years, and the most common admitting diagnoses were heart failure (32%), chronic obstructive pulmonary disease (COPD) (39%), and pneumonia (13%). The median dyspnea score at admission was 9 (interquartile range [IQR] 7-10); decreased to 4 (IQR 2-7) within the first 24 hours; and subsequently plateaued at 48 hours. At discharge, the median score had decreased to 2.75 (IQR 1-4). Compared to patients with heart failure, patients with COPD had higher median dyspnea score at baseline and admission and experienced a slower resolution of dyspnea symptoms. After adjusting for patient characteristics, the change in dyspnea score from admission to discharge was not significantly different between patients hospitalized with congestive heart failure, COPD, or pneumonia.
  
  
  CONCLUSIONS
  Most patients admitted with acute cardiopulmonary conditions have severe dyspnea on presentation, and their symptoms improve rapidly after admission. The trajectory of dyspnea is associated with the underlying disease process. These findings may help set expectations for the resolution of dyspnea symptoms in hospitalized patients with acute cardiopulmonary diseases.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Baystate Medical Center, Springfield, Massachusetts, USA.
authors.forename: Ernest
authors.initials: E
authors.lastname: DiNino
authors.affiliation: Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts, USA; Division of General Internal Medicine, Baystate Medical Center, Springfield, Massachusetts, USA; Tufts Clinical and Translational Science Institute, Boston, Massachusetts, USA; Tufts University School of Medicine, Boston, Massachusetts, USA.
authors.forename: Mihaela S
authors.initials: MS
authors.lastname: Stefan
authors.affiliation: Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts, USA.
authors.forename: Aruna
authors.initials: A
authors.lastname: Priya
authors.affiliation: Tufts University School of Medicine, Boston, Massachusetts, USA.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Martin
authors.affiliation: Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts, USA; School of Public Health and Health Sciences, University of Massachusetts, Amherst, Massachusetts, USA.
authors.forename: Penelope S
authors.initials: PS
authors.lastname: Pekow
authors.affiliation: Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts, USA; Division of General Internal Medicine, Baystate Medical Center, Springfield, Massachusetts, USA; Tufts Clinical and Translational Science Institute, Boston, Massachusetts, USA; Tufts University School of Medicine, Boston, Massachusetts, USA. Electronic address: Peter.Lindenauer@baystatehealth.org.
authors.forename: Peter K
authors.initials: PK
authors.lastname: Lindenauer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D018450:Disease Progression; D004417:Dyspnea / Q000453:epidemiology* / Q000503:physiopathology* / Q000628:therapy; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D011446:Prospective Studies; D012720:Severity of Illness Index; D062606:Tertiary Care Centers; D016896:Treatment Outcome
keywords: Dyspnea; chronic obstructive pulmonary disease; heart failure; hospitalization; pneumonia