title: Changes in Dyspnea Status During Hospitalization and Postdischarge Health-Related Quality of Life in Patients Hospitalized for Heart Failure: Findings From the EVEREST Trial.
abstract: Dyspnea is the most common symptom among hospitalized patients with heart failure and represents a therapeutic target. However, the association between short-term dyspnea relief and postdischarge clinical outcomes and health-related quality of life (HRQOL) remains uncertain.
  
  
  
  A post hoc analysis was performed of the Efficacy of Vasopressin Antagonism in Heart Failure: Outcome Study with Tolvaptan (EVEREST) trial, which enrolled 4133 patients within 48 hours of admission for heart failure with an ejection fraction ≤40%. Physician-assessed dyspnea was recorded on a daily basis from baseline until discharge or day 7 as none, seldom, frequent, or continuous. Patient-reported dyspnea was measured using a 7-point Likert scale, and patients experiencing moderate or marked dyspnea improvement on day 1 were classified as early responders. The Kansas City Cardiomyopathy Questionnaire summary score, which ranges from 0 to 100, was collected postdischarge at week 1. The primary outcome was unfavorable HRQOL, defined a priori as a Kansas City Cardiomyopathy Questionnaire score <45. Secondary outcomes included 30-day all-cause mortality, and all-cause and cause-specific hospitalizations. The final analytic cohort included 1567 patients discharged alive with complete HRQOL data. Patients were 66.0±12.7 years old and had a mean ejection fraction of 25±8%. Physician-assessed dyspnea was rated as frequent or continuous in 1399 patients (90%) at baseline, which decreased to 250 patients (16%) by discharge, whereas patient-reported early dyspnea relief was reported by 610 patients (40%). The median Kansas City Cardiomyopathy Questionnaire score at week 1 was 50 (35, 65). All-cause mortality was 3.0%, and all-cause hospitalization was 20.5% within 30 days of discharge. Physician-assessed and patient-reported dyspnea was not independently associated with HRQOL, all-cause mortality, or all-cause or cause-specific hospitalization.
  
  
  
  In-hospital physician-assessed, and patient-reported dyspnea was not independently associated with postdischarge HRQOL, survival, or readmissions. Although dyspnea relief remains a goal of therapy for hospitalized patients with heart failure with reduced ejection fraction, this measure may not be a reliable surrogate for long-term patient-centered or hard clinical outcomes.
  
  
  
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT00071331.
authors.affiliation: From the Duke University Medical Center, Durham, NC (A.P.A., R.J.M., S.J.G.); Department of Medicine, Emory University School of Medicine, Atlanta, GA (H.K.); Division of Cardiology, Tufts Medical Center and Tufts University School of Medicine, Boston, MA (J.E.U., M.A.K.); Duke Clinical Research Institute, Durham, NC (R.J.M.); Institute of Emergency for Cardiovascular Diseases 'Prof. C.C. Iliescu', University of Medicine and Pharmacy Carol Davila, Bucuresti, Romania (O.C.); Division of Cardiology, Brigham and Women's Hospital, Boston, MA (M.V.); Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (H.P.S., M.G.); Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden (K.S.); Department of Cardiology, INSERM, Nancy University, University de Lorraine, Nancy, France (F.Z.); Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy (A.P.M.); and Stony Brook Heart Institute, Stony Brook, NY (J.B.).
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Ambrosy
authors.affiliation: From the Duke University Medical Center, Durham, NC (A.P.A., R.J.M., S.J.G.); Department of Medicine, Emory University School of Medicine, Atlanta, GA (H.K.); Division of Cardiology, Tufts Medical Center and Tufts University School of Medicine, Boston, MA (J.E.U., M.A.K.); Duke Clinical Research Institute, Durham, NC (R.J.M.); Institute of Emergency for Cardiovascular Diseases 'Prof. C.C. Iliescu', University of Medicine and Pharmacy Carol Davila, Bucuresti, Romania (O.C.); Division of Cardiology, Brigham and Women's Hospital, Boston, MA (M.V.); Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (H.P.S., M.G.); Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden (K.S.); Department of Cardiology, INSERM, Nancy University, University de Lorraine, Nancy, France (F.Z.); Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy (A.P.M.); and Stony Brook Heart Institute, Stony Brook, NY (J.B.).
authors.forename: Hassan
authors.initials: H
authors.lastname: Khan
authors.affiliation: From the Duke University Medical Center, Durham, NC (A.P.A., R.J.M., S.J.G.); Department of Medicine, Emory University School of Medicine, Atlanta, GA (H.K.); Division of Cardiology, Tufts Medical Center and Tufts University School of Medicine, Boston, MA (J.E.U., M.A.K.); Duke Clinical Research Institute, Durham, NC (R.J.M.); Institute of Emergency for Cardiovascular Diseases 'Prof. C.C. Iliescu', University of Medicine and Pharmacy Carol Davila, Bucuresti, Romania (O.C.); Division of Cardiology, Brigham and Women's Hospital, Boston, MA (M.V.); Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (H.P.S., M.G.); Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden (K.S.); Department of Cardiology, INSERM, Nancy University, University de Lorraine, Nancy, France (F.Z.); Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy (A.P.M.); and Stony Brook Heart Institute, Stony Brook, NY (J.B.).
authors.forename: James E
authors.initials: JE
authors.lastname: Udelson
authors.affiliation: From the Duke University Medical Center, Durham, NC (A.P.A., R.J.M., S.J.G.); Department of Medicine, Emory University School of Medicine, Atlanta, GA (H.K.); Division of Cardiology, Tufts Medical Center and Tufts University School of Medicine, Boston, MA (J.E.U., M.A.K.); Duke Clinical Research Institute, Durham, NC (R.J.M.); Institute of Emergency for Cardiovascular Diseases 'Prof. C.C. Iliescu', University of Medicine and Pharmacy Carol Davila, Bucuresti, Romania (O.C.); Division of Cardiology, Brigham and Women's Hospital, Boston, MA (M.V.); Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (H.P.S., M.G.); Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden (K.S.); Department of Cardiology, INSERM, Nancy University, University de Lorraine, Nancy, France (F.Z.); Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy (A.P.M.); and Stony Brook Heart Institute, Stony Brook, NY (J.B.).
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Mentz
authors.affiliation: From the Duke University Medical Center, Durham, NC (A.P.A., R.J.M., S.J.G.); Department of Medicine, Emory University School of Medicine, Atlanta, GA (H.K.); Division of Cardiology, Tufts Medical Center and Tufts University School of Medicine, Boston, MA (J.E.U., M.A.K.); Duke Clinical Research Institute, Durham, NC (R.J.M.); Institute of Emergency for Cardiovascular Diseases 'Prof. C.C. Iliescu', University of Medicine and Pharmacy Carol Davila, Bucuresti, Romania (O.C.); Division of Cardiology, Brigham and Women's Hospital, Boston, MA (M.V.); Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (H.P.S., M.G.); Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden (K.S.); Department of Cardiology, INSERM, Nancy University, University de Lorraine, Nancy, France (F.Z.); Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy (A.P.M.); and Stony Brook Heart Institute, Stony Brook, NY (J.B.).
authors.forename: Ovidiu
authors.initials: O
authors.lastname: Chioncel
authors.affiliation: From the Duke University Medical Center, Durham, NC (A.P.A., R.J.M., S.J.G.); Department of Medicine, Emory University School of Medicine, Atlanta, GA (H.K.); Division of Cardiology, Tufts Medical Center and Tufts University School of Medicine, Boston, MA (J.E.U., M.A.K.); Duke Clinical Research Institute, Durham, NC (R.J.M.); Institute of Emergency for Cardiovascular Diseases 'Prof. C.C. Iliescu', University of Medicine and Pharmacy Carol Davila, Bucuresti, Romania (O.C.); Division of Cardiology, Brigham and Women's Hospital, Boston, MA (M.V.); Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (H.P.S., M.G.); Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden (K.S.); Department of Cardiology, INSERM, Nancy University, University de Lorraine, Nancy, France (F.Z.); Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy (A.P.M.); and Stony Brook Heart Institute, Stony Brook, NY (J.B.).
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Greene
authors.affiliation: From the Duke University Medical Center, Durham, NC (A.P.A., R.J.M., S.J.G.); Department of Medicine, Emory University School of Medicine, Atlanta, GA (H.K.); Division of Cardiology, Tufts Medical Center and Tufts University School of Medicine, Boston, MA (J.E.U., M.A.K.); Duke Clinical Research Institute, Durham, NC (R.J.M.); Institute of Emergency for Cardiovascular Diseases 'Prof. C.C. Iliescu', University of Medicine and Pharmacy Carol Davila, Bucuresti, Romania (O.C.); Division of Cardiology, Brigham and Women's Hospital, Boston, MA (M.V.); Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (H.P.S., M.G.); Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden (K.S.); Department of Cardiology, INSERM, Nancy University, University de Lorraine, Nancy, France (F.Z.); Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy (A.P.M.); and Stony Brook Heart Institute, Stony Brook, NY (J.B.).
authors.forename: Muthiah
authors.initials: M
authors.lastname: Vaduganathan
authors.affiliation: From the Duke University Medical Center, Durham, NC (A.P.A., R.J.M., S.J.G.); Department of Medicine, Emory University School of Medicine, Atlanta, GA (H.K.); Division of Cardiology, Tufts Medical Center and Tufts University School of Medicine, Boston, MA (J.E.U., M.A.K.); Duke Clinical Research Institute, Durham, NC (R.J.M.); Institute of Emergency for Cardiovascular Diseases 'Prof. C.C. Iliescu', University of Medicine and Pharmacy Carol Davila, Bucuresti, Romania (O.C.); Division of Cardiology, Brigham and Women's Hospital, Boston, MA (M.V.); Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (H.P.S., M.G.); Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden (K.S.); Department of Cardiology, INSERM, Nancy University, University de Lorraine, Nancy, France (F.Z.); Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy (A.P.M.); and Stony Brook Heart Institute, Stony Brook, NY (J.B.).
authors.forename: Haris P
authors.initials: HP
authors.lastname: Subacuis
authors.affiliation: From the Duke University Medical Center, Durham, NC (A.P.A., R.J.M., S.J.G.); Department of Medicine, Emory University School of Medicine, Atlanta, GA (H.K.); Division of Cardiology, Tufts Medical Center and Tufts University School of Medicine, Boston, MA (J.E.U., M.A.K.); Duke Clinical Research Institute, Durham, NC (R.J.M.); Institute of Emergency for Cardiovascular Diseases 'Prof. C.C. Iliescu', University of Medicine and Pharmacy Carol Davila, Bucuresti, Romania (O.C.); Division of Cardiology, Brigham and Women's Hospital, Boston, MA (M.V.); Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (H.P.S., M.G.); Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden (K.S.); Department of Cardiology, INSERM, Nancy University, University de Lorraine, Nancy, France (F.Z.); Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy (A.P.M.); and Stony Brook Heart Institute, Stony Brook, NY (J.B.).
authors.forename: Marvin A
authors.initials: MA
authors.lastname: Konstam
authors.affiliation: From the Duke University Medical Center, Durham, NC (A.P.A., R.J.M., S.J.G.); Department of Medicine, Emory University School of Medicine, Atlanta, GA (H.K.); Division of Cardiology, Tufts Medical Center and Tufts University School of Medicine, Boston, MA (J.E.U., M.A.K.); Duke Clinical Research Institute, Durham, NC (R.J.M.); Institute of Emergency for Cardiovascular Diseases 'Prof. C.C. Iliescu', University of Medicine and Pharmacy Carol Davila, Bucuresti, Romania (O.C.); Division of Cardiology, Brigham and Women's Hospital, Boston, MA (M.V.); Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (H.P.S., M.G.); Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden (K.S.); Department of Cardiology, INSERM, Nancy University, University de Lorraine, Nancy, France (F.Z.); Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy (A.P.M.); and Stony Brook Heart Institute, Stony Brook, NY (J.B.).
authors.forename: Karl
authors.initials: K
authors.lastname: Swedberg
authors.affiliation: From the Duke University Medical Center, Durham, NC (A.P.A., R.J.M., S.J.G.); Department of Medicine, Emory University School of Medicine, Atlanta, GA (H.K.); Division of Cardiology, Tufts Medical Center and Tufts University School of Medicine, Boston, MA (J.E.U., M.A.K.); Duke Clinical Research Institute, Durham, NC (R.J.M.); Institute of Emergency for Cardiovascular Diseases 'Prof. C.C. Iliescu', University of Medicine and Pharmacy Carol Davila, Bucuresti, Romania (O.C.); Division of Cardiology, Brigham and Women's Hospital, Boston, MA (M.V.); Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (H.P.S., M.G.); Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden (K.S.); Department of Cardiology, INSERM, Nancy University, University de Lorraine, Nancy, France (F.Z.); Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy (A.P.M.); and Stony Brook Heart Institute, Stony Brook, NY (J.B.).
authors.forename: Faiez
authors.initials: F
authors.lastname: Zannad
authors.affiliation: From the Duke University Medical Center, Durham, NC (A.P.A., R.J.M., S.J.G.); Department of Medicine, Emory University School of Medicine, Atlanta, GA (H.K.); Division of Cardiology, Tufts Medical Center and Tufts University School of Medicine, Boston, MA (J.E.U., M.A.K.); Duke Clinical Research Institute, Durham, NC (R.J.M.); Institute of Emergency for Cardiovascular Diseases 'Prof. C.C. Iliescu', University of Medicine and Pharmacy Carol Davila, Bucuresti, Romania (O.C.); Division of Cardiology, Brigham and Women's Hospital, Boston, MA (M.V.); Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (H.P.S., M.G.); Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden (K.S.); Department of Cardiology, INSERM, Nancy University, University de Lorraine, Nancy, France (F.Z.); Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy (A.P.M.); and Stony Brook Heart Institute, Stony Brook, NY (J.B.).
authors.forename: Aldo P
authors.initials: AP
authors.lastname: Maggioni
authors.affiliation: From the Duke University Medical Center, Durham, NC (A.P.A., R.J.M., S.J.G.); Department of Medicine, Emory University School of Medicine, Atlanta, GA (H.K.); Division of Cardiology, Tufts Medical Center and Tufts University School of Medicine, Boston, MA (J.E.U., M.A.K.); Duke Clinical Research Institute, Durham, NC (R.J.M.); Institute of Emergency for Cardiovascular Diseases 'Prof. C.C. Iliescu', University of Medicine and Pharmacy Carol Davila, Bucuresti, Romania (O.C.); Division of Cardiology, Brigham and Women's Hospital, Boston, MA (M.V.); Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (H.P.S., M.G.); Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden (K.S.); Department of Cardiology, INSERM, Nancy University, University de Lorraine, Nancy, France (F.Z.); Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy (A.P.M.); and Stony Brook Heart Institute, Stony Brook, NY (J.B.).
authors.forename: Mihai
authors.initials: M
authors.lastname: Gheorghiade
authors.affiliation: From the Duke University Medical Center, Durham, NC (A.P.A., R.J.M., S.J.G.); Department of Medicine, Emory University School of Medicine, Atlanta, GA (H.K.); Division of Cardiology, Tufts Medical Center and Tufts University School of Medicine, Boston, MA (J.E.U., M.A.K.); Duke Clinical Research Institute, Durham, NC (R.J.M.); Institute of Emergency for Cardiovascular Diseases 'Prof. C.C. Iliescu', University of Medicine and Pharmacy Carol Davila, Bucuresti, Romania (O.C.); Division of Cardiology, Brigham and Women's Hospital, Boston, MA (M.V.); Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (H.P.S., M.G.); Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden (K.S.); Department of Cardiology, INSERM, Nancy University, University de Lorraine, Nancy, France (F.Z.); Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy (A.P.M.); and Stony Brook Heart Institute, Stony Brook, NY (J.B.). Javed.Butler@stonybrookmedicine.edu.
authors.forename: Javed
authors.initials: J
authors.lastname: Butler
mesh_terms: D000368:Aged; D065092:Antidiuretic Hormone Receptor Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D001552:Benzazepines / Q000009:adverse effects / Q000627:therapeutic use*; D002423:Cause of Death; D004311:Double-Blind Method; D004417:Dyspnea / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000517:prevention & control*; D005260:Female; D006304:Health Status; D006333:Heart Failure / Q000150:complications / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D010359:Patient Readmission; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011788:Quality of Life; D020127:Recovery of Function; D012307:Risk Factors; D013318:Stroke Volume / Q000187:drug effects; D011795:Surveys and Questionnaires; D013997:Time Factors; D000077602:Tolvaptan; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000187:drug effects
chemical_list: D065092:Antidiuretic Hormone Receptor Antagonists; D001552:Benzazepines; D000077602:Tolvaptan
keywords: dyspnea; heart failure; hospitalization; quality of life