Changes in Dyspnea Status During Hospitalization and Postdischarge Health-Related Quality of Life in Patients Hospitalized for Heart Failure: Findings From the EVEREST Trial.

Autor:	Ambrosy AP; 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.)., Khan H; 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.)., Udelson JE; 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.)., Mentz RJ; 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.)., Chioncel O; 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.)., Greene SJ; 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.)., Vaduganathan M; 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.)., Subacuis HP; 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.)., Konstam MA; 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.)., Swedberg K; 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.)., Zannad F; 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.)., Maggioni AP; 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.)., Gheorghiade M; 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.)., Butler J; 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.
Jazyk:	angličtina
Zdroj:	Circulation. Heart failure [Circ Heart Fail] 2016 May; Vol. 9 (5).
DOI:	10.1161/CIRCHEARTFAILURE.115.002458
Abstrakt:	Background: 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. Methods and Results: 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. Conclusions: 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. Clinical Trial Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00071331. (© 2016 American Heart Association, Inc.)
Databáze:	MEDLINE
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