Improvements in signs and symptoms during hospitalization for acute heart failure follow different patterns and depend on the measurement scales used: an international, prospective registry to evaluate the evolution of measures of disease severity in acute heart failure (MEASURE-AHF)

Abstract

Background: The natural evolution of signs and symptoms during acute heart failure (AHF) is poorly characterized.

Methods and results: We followed a prospective international cohort of 182 patients hospitalized with AHF. Patient-reported dyspnea and general well-being (GWB) were measured daily using 7-tier Likert (-3 to +3) and visual analog scales (VAS, 0-100). Physician assessments were also recorded daily. Mean age was 69 years and 68% had ejection fraction <40%. Likert measures of dyspnea initially improved rapidly (day 1, 0.22; day 2, 1.31; P <.001) with no significant improvement thereafter (day 7, 1.51; day 2 versus 7 P = .16). In contrast, VAS measure of dyspnea improved throughout hospitalization (day 1, 50.1; day 2, 64.7; day 7, 83.2; day 1 versus 2 P < .001, day 2 versus 7 P < .001). Symptoms of dyspnea and GWB tracked closely (correlation r = .813, P < .001). Physical signs resolved more completely than did symptoms (eg, from day 1 to discharge/day 7, absence of edema increased from 33% to 72% of patients, whereas significant improvements in dyspnea increased from 27% to 52% of patients; P < .001).

Conclusions: Changes in patient-reported symptoms and physician-assessed signs followed different patterns during an AHF episode and are influenced by the measurement scales used. Multiple clinical measures should be considered in discharge decisions and evaluation of AHF therapies.

Figures

Fig. 1

Mean patient-reported dyspnea scores measured by both the visual analog (VAS) and Likert scales over time compared with physician-elicited orthopnea and dyspnea on exertion measures on transformed scales.

Fig. 2

Patient-reported dyspnea and general well-being scores on visual analog scale.

Fig. 3

Patient-reported dyspnea and general well-being scores on transformed Likert scale.

Fig. 4

Change in mean weight and urine output over time (±SD).

Fig. 5

Distribution of change in weight from admission to last reported.