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The impact of early standard therapy on dyspnoea in patients with acute heart failure: the URGENT-dyspnoea study.

Abstract：

AIMS:The vast majority of acute heart failure (AHF) trials to date have targeted dyspnoea. However, they enrolled patients relatively late and did not standardize their methods of dyspnoea measurement. URGENT Dyspnoea was designed to determine changes in dyspnoea in response to initial, standard therapy in patients presenting with AHF using a standardized approach. METHODS AND RESULTS:URGENT Dyspnoea was an international, multi-centre, observational cohort study of AHF patients managed conventionally and enrolled within 1 h of first hospital medical evaluation. Patient-assessed dyspnoea was recorded in the sitting position at baseline and at 6 hours by Likert and visual analog scales. Less symptomatic patients were placed supine to determine whether this provoked worsening dyspnoea (orthopnoea). Of the 524 patients with AHF, the mean age was 68 years, 43% were women, and 83% received intravenous diuretics. On a 5-point Likert scale, dyspnoea improvement was reported by 76% of patients after 6 h of standard therapy. Supine positioning (orthopnoea test) led to worse dyspnoea in 47% of patients compared to sitting upright. CONCLUSION:When sitting upright, dyspnoea in the sitting position improves rapidly and substantially in patients with AHF after administration of conventional therapy, mainly intra-venous diuretics. However, many patients remain orthopnoeic. Improving the methodology of clinical trials in AHF by standardizing the conditions under which dyspnoea is assessed could enhance their ability to identify effective treatments. Relief of orthopnoea is clinically valuable and may represent a useful goal for clinical trials.

journal_name

Eur Heart J

journal_title

European heart journal

authors

Mebazaa A,Pang PS,Tavares M,Collins SP,Storrow AB,Laribi S,Andre S,Mark Courtney D,Hasa J,Spinar J,Masip J,Frank Peacock W,Sliwa K,Gayat E,Filippatos G,Cleland JG,Gheorghiade M

doi

10.1093/eurheartj/ehp458

subject

Has Abstract

pub_date

2010-04-01 00:00:00

pages

832-41

issue

7

eissn

0195-668X

issn

1522-9645

pii

ehp458

journal_volume

31

pub_type

杂志文章,多中心研究

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