title: Evaluation of a provocative dyspnea severity score in acute heart failure.
abstract: BACKGROUND
  The acute heart failure (AHF) Syndromes International Working Group proposed that dyspnea be assessed under standardized, incrementally provocative maneuvers and called for studies to assess the feasibility of this approach. We sought to assess the feasibility and statistical characteristics of a novel provocative dyspnea severity score (pDS) versus the traditional dyspnea visual analog scale (DVAS) in an AHF trial.
  
  
  METHODS
  At enrollment, 24, 48 and 72hours, 230 ROSE-AHF patients completed a DVAS. Dyspnea was then assessed with 5-point Likert dyspnea scales administered during 4 stages (A: upright-with O2, B: upright-without O2, C: supine-without O2 and D: exercise-without O2). Patients with moderate or less dyspnea were eligible for the next stage.
  
  
  RESULTS
  At enrollment, oxygen withdrawal and supine provocation were highly feasible (≥97%), provoking more severe dyspnea (≥1 Likert point) in 24% and 42% of eligible patients, respectively. Exercise provocation had low feasibility with 38% of eligible patients unable to exercise due to factors other than dyspnea. A pDS was constructed from Likert scales during the 3 feasible assessment conditions (A-C). Relative to DVAS, the distribution of the pDS was more skewed with a high "ceiling effect" at enrollment (23%) limiting sensitivity to change. Change in pDS was not related to decongestion or 60-day outcomes.
  
  
  CONCLUSIONS
  Although oxygen withdrawal and supine provocation are feasible and elicit more severe dyspnea, exercise provocation had unacceptable feasibility in this AHF cohort. The statistical characteristics of a pDS based on feasible provocation measures do not support its potential as a robust dyspnea assessment tool in AHF.
authors: Mayo Clinic, Rochester, MN. Electronic address: Abouezzeddine.Omar@mayo.edu.
authors: Omar F
authors: OF
authors: AbouEzzeddine
authors: Brigham and Women's Hospital, Boston, MA; Mount Sinai Hospital, Icahn School of Medicine, New York, NY.
authors: Anuradha
authors: A
authors: Lala
authors: Duke University Medical Center and Duke Heart Center, Durham, NC.
authors: Prateeti P
authors: PP
authors: Khazanie
authors: Massachusetts General Hospital, Boston, MA.
authors: Ravi
authors: R
authors: Shah
authors: Boston University School of Medicine, Boston, MA.
authors: Jennifer E
authors: JE
authors: Ho
authors: Mayo Clinic, Rochester, MN.
authors: Horng H
authors: HH
authors: Chen
authors: Indiana University School of Medicine, Indianapolis, IN.
authors: Peter S
authors: PS
authors: Pang
authors: Duke Clinical Research Institute, Durham, NC.
authors: Steven E
authors: SE
authors: McNulty
authors: Duke Clinical Research Institute, Durham, NC.
authors: Kevin J
authors: KJ
authors: Anstrom
authors: Duke Clinical Research Institute, Durham, NC.
authors: Adrian F
authors: AF
authors: Hernandez
authors: Mayo Clinic, Rochester, MN.
authors: Margaret M
authors: MM
authors: Redfield
mesh_terms: D000208:Acute Disease; D000368:Aged; D015415:Biomarkers / Q000097:blood; D004417:Dyspnea / Q000175:diagnosis* / Q000209:etiology; D005080:Exercise Test; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index; D013997:Time Factors
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain