Is there a clinically meaningful difference in patient reported dyspnea in acute heart failure? An analysis from URGENT Dyspnea.
Publication/Presentation Date
1-1-2017
Abstract
BACKGROUND: Dyspnea is the most common presenting symptom in patients with acute heart failure (AHF), but is difficult to quantify as a research measure. The URGENT Dyspnea study compared 3 scales: (1) 10 cm VAS, (2) 5-point Likert, and (3) a 7-point Likert (both VAS and 5-point Likert were recorded in the upright and supine positions). However, the minimal clinically important difference (MCID) to patients has not been well established.
METHODS: We performed a secondary analysis from URGENT Dyspnea, an observational, multi-center study of AHF patients enrolled within 1 h of first physician assessment in the ED. Using the anchor-based method to determine the MCID, a one-category change in the 7-point Likert was used as the criterion standard ('minimally improved or worse'). The main outcome measures were the change in visual analog scale (VAS) and 5-point Likert scale from baseline to 6-h assessment relative to a 1-category change response in the 7-point Likert scale ('minimally worse', 'no change', or 'minimally better').
RESULTS: Of the 776 patients enrolled, 491 had a final diagnosis of AHF with responses at both time points. A 10.5 mm (SD 1.6 mm) change in VAS was the MCID for improvement in the upright position, and 14.5 mm (SD 2.0 mm) in the supine position. However, there was no MCID for worsening, as few patients reported worse dyspnea. There was also no significant MCID for the 5-point Likert scale.
CONCLUSION: A 10.5 mm change is the MCID for improvement in dyspnea over 6 h in ED patients with AHF.
Volume
46
Issue
4
First Page
300
Last Page
307
ISSN
1527-3288
Published In/Presented At
Pang, P. S., Lane, K. A., Tavares, M., Storrow, A. B., Shen, C., Peacock, W. F., Nowak, R., Mebazaa, A., Laribi, S., Hollander, J. E., Gheorghiade, M., & Collins, S. P. (2017). Is there a clinically meaningful difference in patient reported dyspnea in acute heart failure? An analysis from URGENT Dyspnea. Heart & lung : the journal of critical care, 46(4), 300–307. https://doi.org/10.1016/j.hrtlng.2017.03.003
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
28433323
Department(s)
Administration and Leadership
Document Type
Article