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

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 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: Unique identifier: NCT00071331.

Authors: Ambrosy, Andrew P AP; Khan, Hassan H; Udelson, James E JE; Mentz, Robert J RJ; Chioncel, Ovidiu O; Greene, Stephen J SJ; Vaduganathan, Muthiah M; Subacuis, Haris P HP; Konstam, Marvin A MA; Swedberg, Karl K; Zannad, Faiez F; Maggioni, Aldo P AP; Gheorghiade, Mihai M; Butler, Javed J

Circulation. Heart failure. 2016 05 01;9(5):419-27. Epub 2016-10-17.

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