The Trajectory of Dyspnea in Hospitalized Patients

DiNino, Ernest; Stefan, Mihaela; Priya, Aruna; Martin, Bernice M.; Pekow, Penelope S.; Lindenauer, Peter K.

doi:10.1016/j.jpainsymman.2015.11.005

Cited by 7 publications

(6 citation statements)

References 27 publications

(27 reference statements)

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“…We found that discrepancy between patients and healthcare providers was more pronounced for patients with COPD. In another study using the same patient cohort, we reported that compared to patients with congestive heart failure, those with COPD had more residual dyspnea at discharge; 1 in 4 patients was discharged with a dyspnea score of 5 of greater, and almost half reported symptoms above their baseline . The results from the current study may explain in part why patients with COPD are discharged with higher levels of dyspnea and should alert healthcare providers on the importance of patient‐reported breathlessness.…”

Section: Discussionmentioning

confidence: 53%

“…In another study using the same patient cohort, we found that compared tp patients with CHF, those with COPD had more residual dyspnea at discharge; one in four patients was discharged with a dyspnea score of 5 of greater, and almost half reported symptoms above their baseline. (24) The results from the current study may explain in part why patients with COPD are discharged with higher levels of dyspnea and should alert healthcare providers on the importance of patient reported breathlessness. Third, the high level of discordance between healthcare providers and patients may explain the under-treatment of dyspnea in patients with advanced disease.…”

Section: Discussionmentioning

confidence: 82%

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How well do patients and providers agree on the severity of dyspnea?

Stefan

Priya

Martin

et al. 2016

Journal of Hospital Medicine

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BACKGROUND Understanding the severity of patients' dyspnea is critical to avoid under‐ or overtreatment of patients with acute cardiopulmonary conditions. OBJECTIVE To evaluate the agreement between dyspnea assessment by patients and healthcare providers and to explore which factors contribute to discordance in assessment. DESIGN, SETTINGS AND PARTICIPANTS Prospective study of patients hospitalized for acute cardiopulmonary diseases at an urban teaching hospital. INTERVENTION AND MEASUREMENTS A numerical rating scale (0–10) was used to assess dyspnea severity as perceived by patients and assessed by providers. Agreement was defined as a score within ±1 between patient and healthcare provider; differences of ≥2 points were considered over‐ or underestimations. The relationship between patient self‐perceived dyspnea severity and provider rating was assessed using a weighted kappa coefficient. RESULTS Of the 138 patients enrolled, 33% had a diagnosis of heart failure, 30% chronic obstructive pulmonary disease, and 13% pneumonia; median age was 72 years, and 57% were women. In all, 96 patient‐physician and 138 patient‐nurses pairs were included in the study. The kappa coefficient for agreement was 0.11 (95% confidence interval [CI]: 0.01 to 0.21) between patients and physicians and 0.18 (95% CI: 0.12 to 0.24) between patients and nurses. Physicians underestimated patients' dyspnea 37.9% of the time and overestimated it 25.8% of the time, whereas nurses underestimated it 43.5% of the time and overestimated it 12.4% of the time. Admitting diagnosis was the only patient factor associated with discordance. CONCLUSIONS Agreement between patient perception of dyspnea and healthcare providers' assessment is low. Future studies should prospectively test whether routine assessment of dyspnea results in better patient outcomes. Journal of Hospital Medicine 2016;11:701–707. © 2016 Society of Hospital Medicine

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Section: Discussionmentioning

confidence: 53%

Section: Discussionmentioning

confidence: 82%

How well do patients and providers agree on the severity of dyspnea?

Stefan

Priya

Martin

et al. 2016

Journal of Hospital Medicine

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“…During hospitalization for an acute exacerbation (AECOPD), functional exercise capacity and quadriceps muscle strength are negatively impacted [ 7 , 8 , 9 ]. Assessment of physical functioning at the end of an AECOPD-related hospitalization may be difficult in patients with COPD, as they may still suffer from severe dyspnea and fatigue [ 10 , 11 ]. However, this may provide an important indication for early referral for pulmonary rehabilitation [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Physical Tests Are Poorly Related to Patient-Reported Outcome Measures during Severe Acute Exacerbations of COPD

Quadflieg

Machado

Haesevoets

et al. 2021

JCM

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Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) have a negative impact on patients’ health status, including physical function and patient-reported outcomes. We aimed to explore the associations between physical tests and patient-reported outcome measures (PROMs) in hospitalised patients for an AECOPD. Patients were assessed on the day of discharge. Quadriceps force, handgrip strength, short physical performance battery (SPPB), five-repetition sit-to-stand test (5STS), four-meter gait speed test (4MGS), balance test, six-minute walk test (6MWT), COPD Assessment Test (CAT), London Chest Activity of Daily Living scale (LCADL), modified Medical Research Council (mMRC) dyspnea scale, Checklist of Individual Strength (CIS)-fatigue subscale, and Patient Health Questionnaire (PHQ-9) were collected. Sixty-nine patients with an AECOPD were included (54% female; age 69 ± 9 years; FEV1 39.2 (28.6–49.1%) predicted). Six-minute walk distance was strongly correlated with mMRC (ρ: −0.64, p < 0.0001) and moderately correlated with LCADL total score, subscales self-care and household activities (ρ ranging from −0.40 to −0.58, p < 0.01). Moreover, 4MGS was moderately correlated with mMRC (ρ: −0.49, p < 0.0001). Other correlations were weak or non-significant. During a severe AECOPD, physical tests are generally poorly related to PROMs. Therefore, a comprehensive assessment combining both physical tests and PROMs needs to be conducted in these patients to understand their health status.

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“…For example, chest pain, another common ED complaint, is associated with a much lower rate of readmission 24 . Altogether, our results suggest that readmission may be linked to the persistent underlying disease despite seemingly resolved symptoms 25 . There is an urgent need of randomized trials investigating if diagnostic work‐up and short and long‐term personalized management of patients with acute dyspnoea including biomarkers and/or lung ultrasound could improve prognosis of this heterogeneous patient group.…”

Section: Discussionmentioning

confidence: 77%

“…24 Altogether, our results suggest that readmission may be linked to the persistent underlying disease despite seemingly resolved symptoms. 25 There is an urgent need of randomized trials investigating if diagnostic work-up and short and long-term personalized management of patients with acute dyspnoea including biomarkers and/ or lung ultrasound could improve prognosis of this heterogeneous patient group. Our data also urge, in case of heart failure, the rapid implementation of guideline-recommended therapies.…”

Section: Discussionmentioning

confidence: 99%

Readmission following both cardiac and non‐cardiac acute dyspnoea is associated with a striking risk of death

et al. 2021

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Aims Readmission and mortality are the most common and often combined endpoints in acute heart failure (AHF) trials, but an association between these two outcomes is poorly investigated. The aim of this study was to determine whether unplanned readmission is associated with a greater subsequent risk of death in patients with acute dyspnoea due to cardiac and non-cardiac causes. Methods and results Derivation cohort (1371 patients from the LEDA study) and validation cohort (1986 patients from the BASEL V study) included acute dyspnoea patients admitted to the emergency department. Cox regression analysis was used to determine the association of 6 month readmission and the risk of 1 year all-cause mortality in AHF and non-AHF patients and those readmitted due to cardiovascular and non-cardiovascular causes. In the derivation cohort, 666 (49%) of patients were readmitted at 6 months and 282 (21%) died within 1 year. Six month readmission was associated with an increased 1 year mortality risk in both the derivation cohort [adjusted hazard ratio (aHR) 3.0 (95% confidence interval, CI 2.2-4.0), P < 0.001] and the validation cohort (aHR 1.8, 95% CI 1.4-2.2, P < 0.001). The significant association was similarly observed in AHF (aHR 3.2, 95% CI 2.1-4.9, P < 0.001) and other causes of acute dyspnoea (aHR 2.9, 95% CI 1.9-4.5, P < 0.001), and it did not depend on the aetiology [aHR 2.2, 95% CI 1.6-3.1 for cardiovascular readmissions; aHR 4.1, 95% CI 2.9-5.7 for non-cardiovascular readmissions (P < 0.001 for both)] or timing of readmission. Conclusions Our study demonstrated a long-lasting detrimental association between readmission and death in AHF and non-AHF patients with acute dyspnoea. These patients should be considered 'vulnerable patients' that require personalized follow-up for an extended period.

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The Trajectory of Dyspnea in Hospitalized Patients

Cited by 7 publications

References 27 publications

How well do patients and providers agree on the severity of dyspnea?

How well do patients and providers agree on the severity of dyspnea?

Physical Tests Are Poorly Related to Patient-Reported Outcome Measures during Severe Acute Exacerbations of COPD

Readmission following both cardiac and non‐cardiac acute dyspnoea is associated with a striking risk of death

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