Assessment of Dyspnea Early in Acute Heart Failure: Patient Characteristics and Response Differences Between Likert and Visual Analog Scales
Pang, Peter S.; Collins, Sean P.; Sauser, Kori; Andrei, Adin‐cristian; Storrow, Alan B.; Hollander, Judd E.; Tavares, Miguel; Spinar, Jindrich; Macarie, Cezar; Raev, Dimitar; Nowak, Richard; Gheorghiade, Mihai; Mebazaa, Alexandre
2014-06
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Citation
Pang, Peter S.; Collins, Sean P.; Sauser, Kori; Andrei, Adin‐cristian ; Storrow, Alan B.; Hollander, Judd E.; Tavares, Miguel; Spinar, Jindrich; Macarie, Cezar; Raev, Dimitar; Nowak, Richard; Gheorghiade, Mihai; Mebazaa, Alexandre (2014). "Assessment of Dyspnea Early in Acute Heart Failure: Patient Characteristics and Response Differences Between Likert and Visual Analog Scales." Academic Emergency Medicine (6): 659-666.
Abstract
Background Dyspnea is the most common symptom in acute heart failure ( AHF ), yet how to best measure it has not been well defined. Prior studies demonstrate differences in dyspnea improvement across various measurement scales, yet these studies typically enroll patients well after the emergency department (ED) phase of management. Objectives The aim of this study was to determine predictors of early dyspnea improvement for three different, commonly used dyspnea scales (i.e., five‐point absolute Likert scale, 10‐cm visual analog scale [ VAS ], or seven‐point relative Likert scale). Methods This was a post hoc analysis of URGENT Dyspnea, an observational study of 776 patients in 17 countries enrolled within 1 hour of first physician encounter. Inclusion criteria were broad to reflect real‐world clinical practice. Prior literature informed the a priori definition of clinically significant dyspnea improvement. Resampling‐based multivariable models were created to determine patient characteristics significantly associated with dyspnea improvement. Results Of the 524 AHF patients, approximately 40% of patients did not report substantial dyspnea improvement within the first 6 hours. Baseline characteristics were similar between those who did or did not improve, although there were differences in history of heart failure, coronary artery disease, and initial systolic blood pressure. For those who did improve, patient characteristics differed across all three scales, with the exception of baseline dyspnea severity for the VAS and five‐point Likert scale (c‐index ranged from 0.708 to 0.831 for each scale). Conclusions Predictors of early dyspnea improvement differ from scale to scale, with the exception of baseline dyspnea. Attempts to use one scale to capture the entirety of the dyspnea symptom may be insufficient. Resumen Antecedentes La disnea es el síntoma más frecuente en la insuficiencia cardiaca aguda ( ICA ), sin embargo no ha sido bien definida la mejor manera de medirla. Estudios previos demuestran diferencias en la mejoría de la disnea a través de varias escalas de medida, sin embargo estos estudios suelen reclutar pacientes bastante después de la fase de manejo en el SU . Objetivos El objetivo de este estudio fue determinar los predictores precoces de mejoría de la disnea para tres escalas de disnea diferentes frecuentemente utilizadas (escala Likert absoluta de 5 puntos, escala visual analógica [ EVA ] de 10 cm o escala Likert relativa de 7 puntos). Métodos Se trata de un análisis post hoc del estudio observacional Disnea URGENTE , que reclutó 776 pacientes dentro de la primera hora tras la primera valoración médica en 17 países. Los criterios de inclusión fueron amplios para reflejar la práctica clínica en el mundo real. La literatura previa documentó la definición a priori de la mejoría significativa de disnea. Se crearon modelos multivariables basados en el remuestreo para determinar las características de los pacientes significativamente asociadas con la mejoría de la disnea. Resultados De los 524 pacientes con ICA , aproximadamente un 40% de los pacientes no documentaron una mejoría sustancial de la disnea en las 6 primeras horas. Las características basales fueron similares entre los que mejoraron y los que no, aunque hubo diferencias en la historia de insuficiencia cardiaca, enfermedad coronaria y presión arterial sistólica inicial. Para aquéllos que mejoraron, las características del paciente difirieron en las tres escalas, con la excepción de la gravedad de la disnea basal para la EVA y en la escala Likert de 5 puntos (el índice‐c varió desde 0,708 hasta 0,831 para cada escala). Conclusiones Los predictores de la mejoría precoz de disnea difieren dependiendo de la escala, con la excepción de la disnea basal. Los intentos para utilizar una sola escala para categorizar la totalidad del síntoma disnea pueden ser insuficientes.Publisher
Wiley Periodicals, Inc.
ISSN
1069-6563 1553-2712
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