title: Evaluation of Novel Metrics of Symptom Relief in Acute Heart Failure: The Worst Symptom Score.
abstract: OBJECTIVE
  To characterize a novel "worst"-symptom visual analogue scale (WS-VAS) versus the traditional dyspnea visual analogue scale (DVAS) in an acute heart failure (AHF) trial.
  
  
  BACKGROUND
  AHF trials assess symptom relief as a pivotal endpoint with the use of dyspnea scores. However, many AHF patients' worst presenting symptom (WS) may not be dyspnea. We hypothesized that a WS-VAS may reflect clinical improvement better than DVAS in AHF.
  
  
  RESULTS
  AHF patients (n = 232) enrolled in the Renal Optimization Strategies Evaluation in Acute Heart Failure (ROSE-AHF) Trial indicated their WS at enrollment and completed DVAS and WS-VAS at enrollment and 24, 48, and 72 hours. Dyspnea was the WS in 61%, body swelling in 29%, and fatigue in 10% of patients. Clinical characteristics differed by WS. In all patients, DVAS scores were higher (less severe symptoms) than WS-VAS and the change in WS-VAS over 72 hours was greater than the change in DVAS (P < .001). Changes in DVAS were smaller in patients with body swelling and fatigue than in patients with dyspnea as their WS (P = .002), whereas changes in the WS-VAS were similar regardless of patients' WS. Neither score, nor its change, was associated with available decongestion markers (change in N-terminal pro-B-type natriuretic peptide, weight or cumulative 72-hour urine volume).
  
  
  CONCLUSIONS
  Many AHF patients have symptoms other than dyspnea as their most bothersome symptom. The WS-VAS better reflects symptom improvement across the spectrum of AHF phenotypes. Symptom relief and decongestion were not correlated in this AHF study.
authors.affiliation: Department of Cardiology, Mayo Clinic, Rochester, Minnesota. Electronic address: abouezzeddine.omar@mayo.edu.
authors.forename: Omar F
authors.initials: OF
authors.lastname: AbouEzzeddine
authors.affiliation: Division of Cardiology, Department of Medicine, Duke University Medical Center and Duke Heart Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Yee Weng
authors.initials: YW
authors.lastname: Wong
authors.affiliation: Division of Cardiology, Department of Medicine, Duke University Medical Center and Duke Heart Center, Durham, North Carolina; Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Mentz
authors.affiliation: Department of Medicine, Cardiology Unit, Cardiovascular Research Institute, University of Vermont, Burlington, Vermont.
authors.forename: Sadi S
authors.initials: SS
authors.lastname: Raza
authors.affiliation: Department of Medicine, University of Utah Health Care, Salt Lake City, Utah.
authors.forename: Jose
authors.initials: J
authors.lastname: Nativi-Nicolau
authors.affiliation: Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
authors.forename: Robb D
authors.initials: RD
authors.lastname: Kociol
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Steven E
authors.initials: SE
authors.lastname: McNulty
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Anstrom
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina.
authors.forename: Adrian F
authors.initials: AF
authors.lastname: Hernandez
authors.affiliation: Department of Cardiology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Margaret M
authors.initials: MM
authors.lastname: Redfield
mesh_terms: D000208:Acute Disease; D000368:Aged; D015415:Biomarkers / Q000097:blood; D004232:Diuretics / Q000627:therapeutic use*; D004417:Dyspnea / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology*; D004487:Edema / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D005221:Fatigue / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010147:Pain Measurement; D011379:Prognosis; D051437:Renal Insufficiency / Q000503:physiopathology*; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D004232:Diuretics; D020097:Natriuretic Peptide, Brain
keywords: Acute heart failure; clinical trials; quality of life