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Randomized Controlled Trial
. 2013 Apr;15(4):456-64.
doi: 10.1093/eurjhf/hfs188. Epub 2012 Nov 15.

Predictors of early dyspnoea relief in acute heart failure and the association with 30-day outcomes: findings from ASCEND-HF

Robert J Mentz  1 , Adrian F Hernandez, Amanda Stebbins, Justin A Ezekowitz, G Michael Felker, Gretchen M Heizer, Dan Atar, John R Teerlink, Robert M Califf, Barry M Massie, Vic Hasselblad, Randall C Starling, Christopher M O'Connor, Piotr Ponikowski
Affiliations
Randomized Controlled Trial

Predictors of early dyspnoea relief in acute heart failure and the association with 30-day outcomes: findings from ASCEND-HF

Robert J Mentz et al. Eur J Heart Fail. 2013 Apr.

Abstract

Aims: To examine the characteristics associated with early dyspnoea relief during acute heart failure (HF) hospitalization, and its association with 30-day outcomes.

Methods and results: ASCEND-HF was a randomized trial of nesiritide vs. placebo in 7141 patients hospitalized with acute HF in which dyspnoea relief at 6 h was measured on a 7-point Likert scale. Patients were classified as having early dyspnoea relief if they experienced moderate or marked dyspnoea improvement at 6 h. We analysed the clinical characteristics, geographical variation, and outcomes (mortality, mortality/HF hospitalization, and mortality/hospitalization at 30 days) associated with early dyspnoea relief. Early dyspnoea relief occurred in 2984 patients (43%). In multivariable analyses, predictors of dyspnoea relief included older age and oedema on chest radiograph; higher systolic blood pressure, respiratory rate, and natriuretic peptide level; and lower serum blood urea nitrogen (BUN), sodium, and haemoglobin (model mean C index = 0.590). Dyspnoea relief varied markedly across countries, with patients enrolled from Central Europe having the lowest risk-adjusted likelihood of improvement. Early dyspnoea relief was associated with lower risk-adjusted 30-day mortality/HF hospitalization [hazard ratio (HR) 0.81; 95% confidence interval (CI) 0.68-0.96] and mortality/hospitalization (HR 0.85; 95% CI 0.74-0.99), but similar mortality.

Conclusion: Clinical characteristics such as respiratory rate, pulmonary oedema, renal function, and natriuretic peptide levels are associated with early dyspnoea relief, and moderate or marked improvement in dyspnoea was associated with a lower risk for 30-day outcomes.

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Figures

Figure 1
Figure 1
Observed moderate to marked improvement in dyspnoea at 6 h by country of enrolment.
See this image and copyright information in PMC

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