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

Alexandre Mebazaa, Peter S. Pang, Miguel Tavares, Sean P. Collins, Alan B. Storrow, Said Laribi, Stephanie Andre, Daniel Mark Courtney, Jennifer Hasa, Jindrich Spinar, Josep Masip, William Frank Peacock, Karen Sliwa, Etienne Gayat, Gerasimos Filippatos, John G.F. Cleland, Mihai Gheorghiade

Research output: Contribution to journalArticle

115 Scopus citations

Abstract

AimsThe 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 resultsURGENT 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.ConclusionWhen 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.

Original languageEnglish (US)
Pages (from-to)832-841
Number of pages10
JournalEuropean heart journal
Volume31
Issue number7
DOIs
StatePublished - Apr 2010

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Keywords

  • Acute heart failure
  • Dyspnoea
  • Orthopnoea

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Mebazaa, A., Pang, P. S., Tavares, M., Collins, S. P., Storrow, A. B., Laribi, S., Andre, S., Mark Courtney, D., Hasa, J., Spinar, J., Masip, J., Frank Peacock, W., Sliwa, K., Gayat, E., Filippatos, G., Cleland, J. G. F., & Gheorghiade, M. (2010). The impact of early standard therapy on dyspnoea in patients with acute heart failure: The URGENT-dyspnoea study. European heart journal, 31(7), 832-841. https://doi.org/10.1093/eurheartj/ehp458