Ezekowitz, J.A., Hernandez, A.F., O'Connor, C.M., Starling, R.C., Proulx, G., Weiss, M.H., Bakal, J.A., Califf, R.M., McMurray, J.J.V. and Armstrong, P.W. (2012) Assessment of dyspnea in acute decompensated heart failure: insights from ASCEND-HF (Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure) on the contributions of peak expiratory flow. Journal of the American College of Cardiology, 59(16), pp. 1441-1448. (doi: 10.1016/j.jacc.2011.11.061)
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Abstract
Objectives: This study hypothesized that peak expiratory flow rate (PEFR) would increase with acute heart failure (AHF) treatment over the first 24 h, related to a Dyspnea Index (DI) change and treatment effect. <p/>Background: Dyspnea is a key symptom and clinical trial endpoint in AHF, yet objective assessment is lacking. <p/>Methods: In a clinical trial substudy, 421 patients (37 sites) underwent PEFR testing at baseline, 1, 6, and 24 h after randomization to nesiritide or placebo. DI (by Likert scale) was collected at hours 6 and 24. <p/>Results: Patients were median age 70 years, and 34% were female; no significant differences between nesiritide or placebo patients existed. Median baseline PEFR was 225 l/min (interquartile range [IQR]: 160 to 300 l/min) and increased to 230 l/min (2.2% increase; IQR: 170 to 315 l/min) by hour 1, 250 l/min (11.1% increase; IQR: 180 to 340 l/min) by hour 6, and 273 l/min (21.3% increase; IQR: 200 to 360 l/min) by 24 h (all p < 0.001). The 24-h PEFR change related to moderate or marked dyspnea improvement by DI (adjusted odds ratio: 1.04 for each 10 l/min improvement [95% confidence interval (CI): 1.07 to 1.10]; p < 0.01). A model incorporating time and treatment over 24 h showed greater PEFR improvement after nesiritide compared with placebo (p = 0.048). <p/>Conclusions: PEFR increases over the first 24 h in AHF and could serve as an AHF endpoint. Nesiritide had a greater effect than placebo on PEFR, and this predicted patients with moderate/marked improvement in dyspnea, thereby providing an objective metric for assessing AHF. (Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure [ASCEND-HF]; NCT00475852).
Item Type: | Articles |
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Status: | Published |
Refereed: | Yes |
Glasgow Author(s) Enlighten ID: | McMurray, Professor John |
Authors: | Ezekowitz, J.A., Hernandez, A.F., O'Connor, C.M., Starling, R.C., Proulx, G., Weiss, M.H., Bakal, J.A., Califf, R.M., McMurray, J.J.V., and Armstrong, P.W. |
College/School: | College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health |
Journal Name: | Journal of the American College of Cardiology |
Publisher: | Elsevier Inc. |
ISSN: | 0735-1097 |
Published Online: | 09 April 2012 |
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